Abstract 14702: Elevated Left Ventricular Diastolic Filling Pressure by Tissue Doppler Imaging and Silent Brain Infarction in Patients With Nonvalvular Atrial Fibrillation
Introduction: Left atrial (LA) abnormalities detected by transesophageal echocardiography (TEE) are well known risk factors for thromboembolism in patients with nonvalvular atrial fibrillation (NVAF). On the other hand, recent studies reported that left ventricular (LV) diastolic filling pressure assessed by tissue Doppler imaging (TDI) using transthoracic echocardiography (TTE) is associated with left atrial (LA) blood stasis in these patients. The purpose of this study was to evaluate the possible association of diastolic TDI parameters with silent brain infarction (SBI) on brain MRI which relates dementia in NVAF patients.
Methods: The study population consisted of 171 neurologically asymptomatic patients with NVAF who were scheduled to undergo TEE prior to transcatheter ablation (128 men; mean age, 62 ± 11 years). Mitral inflow E velocity and mitral annulus velocity by TDI (e’) were measured by TTE and E/e’ ratios were calculated. SBI was screened by brain MRI in all patients.
Results: Of 171 patients, SBI was detected in 47 patients (27%). Patients in the highest tertile of E/e’ (>12.3) had a greater prevalence of LA abnormalities such as LA thrombus or spontaneous echo contrast assessed by TEE compared to those with the intermediate (9.1-12.2) or the lowest (<9.1) tertiles of E/e’ (28% vs. 9% vs 9%; P<0.05, respectively). Logistic multivariate analysis after adjustment for age and CHA2DS2-Vasc score ≥2 revealed that the highest tertile of E/e’ was an independent predictor for the presence of SBI on brain MRI (OR 2.58, 95%CI 1.19-5.62; P<0.05).
Conclusions: In this study, high LV diastolic filling pressure by TDI was closely associated with LA abnormalities by TEE and the presence of SBI, suggesting that diastolic TDI measurements are noninvasive and useful method for the risk stratification of SBI in patients with NVAF.
Author Disclosures: S. Ishikawa: None. K. Sugioka: None. S. Iwata: None. N. Norioka: None. S. Nonin: None. Y. Kawai: None. S. Fujita: None. A. Ito: None. M. Takagi: None. M. Yoshiyama: None.
- © 2016 by American Heart Association, Inc.