Abstract 13540: Left Atrial Appendage Dysfunction in Acute Cerebral Embolism Patients with Sinus Rhythm. Correlation with Pulse Wave Tissue Doppler Imaging
Background: With left atrial appendage (LAA) peak flow velocities (LAA-eV) ≥0.55m/s there is minimal risk of thrombus formation in patients in sinus rhythm (SR), suggesting that values of LAA-eV <0.55 m/s may be an indicator of LAA dysfunction (LAAD). Recently, tissue Doppler imaging offers a new technique for assessing left atrial (LA) function.
Methods: Transthoracic and transesophageal echocardiograms were performed in 60 consecutive patients in SR without obvious left ventricular dysfunction within two weeks after an acute cerebral embolic event. Two groups were identified: patients with LAAD (LAA-eV < 0.55m/s, n=20, 65±10 years) and without LAAD (LAA-eV ≥ 0.55 m/s, n=40, 64±10 years). The time interval from P wave onset on the electrocardiogram to the peak of the pulse wave at end-diastole on anterior LA tissue Doppler imaging (PA-TDI) and the peak velocity of the pulse wave (la’) were measured to determine direct LA function.
Results: Paroxysmal atrial fibrillation (PAF) was detected by history in 60% of patients with LAAD and 15% of patients without LAAD. LAA-eV, fractional area changes (LAA-FAC), and la’ were significantly decreased and the PA-TDI interval was significantly prolonged in patients with vs. without PAF (0.50±0.21 vs. 0.77±0.25 m/s, p<0.001; 57±28 vs. 90±17 %, p<0.0001; 5.5±1.8 vs. 7.3±2.0 cm/s, p<0.01; 147±20 vs. 119±24 ms, p<0.0001, respectively). In the two groups with vs. without LAAD the PA-TDI interval was significantly prolonged, la’ significantly decreased, and left atrial volume index significantly increased (139±25 vs. 121±25 ms, p<0.05; 4.9±1.4 vs. 7.7±1.8 cm/s, p<0.0001; 32±13 vs. 24±13 ml/m2, p<0.05, respectively). Multivariate logistic regression analysis revealed that only la’ was an independent predictor of LAAD (OR= 0.437, 95% CI=0.241-0.793, p<0.01). Furthermore, la’ was significantly correlated with LAA-eV (r=0.594, p<0.0001) and LAA-FAC (r=0.682, p<0.0001), and using receiver-operating characteristics analysis the optimal cut-off value for LAA-eV<0.55 m/s was 5.5 cm/s (sensitivity 83%, specificity 88%).
Conclusions: la’ may be a strong predictor of LAAD in acute cerebral embolism patients with SR.
- © 2012 by American Heart Association, Inc.