Abstract 11896: Left Atrial Appendage Wall Velocity Obtained by Transthoracic Echocardiography May be a Feasible Parameter to Detect High Risk Stroke Patients Despite Low CHADS2 Score
It was reported that there are 3 % per year of thromboembolic events even in patients with nonvalvular atrial fibrillation despite low CHADS2 score (0-1). We recently reported that left atrial appendage (LAA) wall velocity obtained by transthoracic echocardiography (TTE-LAWV) can noninvasively evaluate LAA dysfunction which causes LAA thrombus. Therfore, we hypothesized that TTE-LAWV can predict the prevalence of LAA thrombus formation in ischemic stroke patients with low CHADS2 score. Transthoracic and transesophageal echocardiography (TEE) were performed in 167 patients (106 males, mean age 63 ± 13 years), with acute ischemic stroke within 7 days after the onset, who had 0-1 of CHADS2 score before the onset. TTE-LAWV was measured by Doppler tissue imaging at LAA tip from parasternal short axis view of TTE as previously reported. LAA thrombi were detected in 3 of 53 patients (5%) with CHADS2 score 0, and in 7 of 114 patients (6%) with CHADS2 score 1. TTE-LAWV was significantly lower in patients with LAA thrombus than in those without (8.5 ± 2.5 vs. 14.1 ± 4.7 cm/s, P<0.01). TTE-LAWV was significantly lower in patients with CHADS2 score 1 than in those with CHADS2 score 0 (13.1 ± 4.0 vs. 15.0 ± 6.0 cm/s, P<0.05). The optimal cut off value of TTE-LAWV for predicting LAA thrombus was determined for 9.7 cm/s (Figure). Patients with TTE-LAWV >9.7 cm/s had no LAA thrombus in CHADS2 score 0, and only 2 patients with CHADS2 score 1. The multivariate logistic regression analysis showed that TTE-LAWV > 9.7 cm/s was an independent predictor of LAA thrombus (odds ratio 18.1; 95% confidence interval 3.1-104.8; P<0.01). In conclusion, TTE-LAWV may be useful for the risk stratification of thromboembolism even in patients with low CHADS2 score.
- © 2011 by American Heart Association, Inc.