Abstract 12993: Left Atrial Dysfunction Score Evaluated by Multiple Echocardiographic Parameters Predicts Left Atrial Appendage Thrombus Formation in Patients with Acute Ischemic Stroke
It is important to evaluate left atrial appendage (LAA) dysfunction for primary and secondary prevention of stroke in patients with atrial fibrillation. It is well known that transesophageal echocardiography (TEE) is useful for evaluating LAA function,but TEE is a semi-invasive procedure. Many clinical studies have shown a close relationship between LAA thrombus formation and left atrial (LA) and LAA mechanical remodeling. Therefore, we evaluated whether multiple echocardiographic parameters evaluated by transthoracic echocardiography (TTE) predict LAA thrombus formation in patients with acute ischemic stroke. TTE and TEE were performed in 208 patients (124 males, mean age 71 ± 13 years) with acute ischemic stroke within 7 days after the onset. We defined that left atrial dysfunction score (LADS) was formed by assigning 1 point each for the presence of the abnormal value for left atrial volume index (LAVI, positive if > 43), left atrial ejection fraction (LAEF, positive if < 27%), and left atrial appendage wall velocity (LAWV, positive if < 9.8). LAWV was measured by Doppler tissue imaging at LAA tip from parasternal short axis view of TTE as previously reported. Cut-off values of each parameters were obtained by using receiver operating characteristics (ROC) curves, respectively.LAA thrombus was detected in 37 patients (18%). LADS was significantly higher in patients with LAA thrombus than in those without (2.46 ± 0.90 vs. 0.79 ± 1.00 cm/s, P<0.01). LAA emptying flow velocity decreases with advancing LADS. The optimal cut off value of LADS for predicting LAA thrombus was determined for 2 (Figure). Multivariate logistic regression analysis showed that increasing LADS was an independent predictor of LAA thrombus (odds ratio 2.731, 95% confidence interval 1.572-5.124; p<0.01). In conclusion, increasing LADS may be a feasible tool for predicting LAA dysfunction and thrombus formation in patients with acute ischemic stroke.
- © 2012 by American Heart Association, Inc.