Abstract 14120: Mechanical Function of Left Atrial Appendage is Associated with the Degree of Electroanatomical Remodeling of Left Atrium, Left Ventricular Diastolic Function, and Risk or Event of Stroke in Patients with Paroxysmal Atrial Fibrillation
Background: We previously reported that the degree of electroanatomical remodeling of the left atrium (LA) is closely related to the events and risk of stroke in patients with atrial fibrillation (AF). We hypothesized that LA appendage (LAA) flow velocity (FV) during sinus rhythm is associated with LA electroanatomical remodeling, left ventricular (LV) diastolic function, and risk or event of stroke/ transient ischemic attack (TIA) in patients with paroxysmal AF (PAF).
Methods: We included 286 patients with paroxysmal AF (PAF; male 72.4%, 56.8±11.3 years old) who underwent trans-esophageal echocardiography (TEE) during sinus rhythm and radiofrequency catheter ablation (RFCA). Depending on LAA-FV, we compared them with clinical characteristics, echo or CT findings, and electroanatomical voltage map (NavX).
Results: 1. In patients with LAA-FV<58m/s, CHADS2 score (1.08± 1.19 vs. 0.74± 0.90, p=0.004), previous stroke/TIA rate (7.4% vs. 3.0%, p=0.004), LA volume/BSA (65.0±18.0mL/m2 vs. 59.6±18.2mL/m2, p=0.013), E/E’ (10.3±4.4 vs. 9.2±3.6, p=0.017) were higher, and mean LA voltage (1.38± 0.63mV vs. 1.55± 0.64mV, p=0.047) was lower than in those with LAA-FV≥58m/s. 2. When we compared the patient group with E/E’≤8 (n=110), E/E’8∼15 (n=116), and E/E’>15 (n=28), E/E’>15 group showed greater LA size (p=0.001), low LA voltage (p=0.010), older age (p<0.001), higher CHADS2 score (p=0.003), and events of stroke/TIA (p=0.008). 3. In multi-variate regression analysis, LA volume/BSA (OR0.970, 95% CI 0.946-0.991, p=0.015) and LAA voltage (OR1.337, 95% CI 1.046-1.812, p=0.022) were independent predictors for LAA-FV, and LAA-FV was an independent predictor for ischemic stroke/TIA (OR0.976, 95% CI 0.955-0.998, p=0.030).
Conclusion: In patients with PAF, LAA-FV measured in SR was associated with CHADS2 score, events of stroke/TIA, LV diastolic function, and LA electroanatomical remodeling. LAA-FV was an independent predictor for ischemic stroke/TIA in patients with PAF.
- © 2012 by American Heart Association, Inc.