Abstract 12917: Left Atrial Appendage Wall Velocity Obtained by Transthoracic Echocardiography May Be a Feasible Parameter to Detect High Risk Patients for Stroke Despite Low CHA2DS2-VASc Score
CHA2DS2-VASc score (congestive heart failure, hypertension, age ≥75 [double], diabetes, stroke [double], vascular disease, age 65-74, and female) was a recommended detailed stroke risk assessment approach for patients with atrial fibrillation (AF) in the recently published guidelines. Some patients with AF suffer from ischemic stroke despite low CHA2DS2-VASc score. 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. We hypothesized that TTE-LAWV can risk stratify patients with AF despite low CHA2DS2-VASc score (0-2). Transthoracic and transesophageal echocardiography (TEE) were performed in 980 consecutive patients with acute ischemic stroke within 7 days after the onset, and 42 patients who had 0-2 of CHA2DS2-VASc score before the onset (37 males, mean age 63 ± 8 years) were enrolled. All patients had atrial fibrillation. TTE-LAWV was measured by Doppler tissue imaging at LAA tip from parasternal short axis view of TTE as previously reported. Eight of 42 patients had LAA thrombi (19%). TTE-LAWV was significantly lower in patients with LAA thrombi and/or severe LAA spontaneous echo contrast (LAA-SEC) than in those without (7.7 ± 0.7 vs. 11.8 ± 0.7 cm/s, P<0.01). The optimal cut off value of TTE-LAWV for predicting LAA thrombus and/or LAA-SEC was determined for 9.23 cm/s (Figure). The multivariate logistic regression analysis showed that TTE-LAWV < 9.23 cm/s was an independent predictor of LAA thrombus and/or LAA-SEC (odds ratio 14.6; 95% confidence interval 2.9-102.0; P<0.01). In conclusion, TTE-LAWV may be useful for the risk stratification of thromboembolism even in patients with low CHA2DS2-VASc score.
- © 2012 by American Heart Association, Inc.