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J Am Soc Echocardiogr. 2016 Jun;29(6):545-53. doi: 10.1016/j.echo.2016.01.014. Epub 2016 Mar 25.

Impact of Diastolic Function Parameters on the Risk for Left Atrial Appendage Thrombus in Patients with Nonvalvular Atrial Fibrillation: A Prospective Study.

Author information

1
Division of Adult Cardiology, John H. Stroger, Jr Hospital of Cook County, Chicago, Illinois; Division of Cardiology, Rush University Medical Center, Chicago, Illinois. Electronic address: rami_doukky@rush.edu.
2
Division of Cardiology, Rush University Medical Center, Chicago, Illinois; Division of Cardiology, Mount Sinai Hospital, Chicago, Illinois.
3
Division of Cardiology, Rush University Medical Center, Chicago, Illinois; Division of Cardiology, Medical College of Wisconsin, Milwaukee, Wisconsin.
4
Division of Cardiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois.
5
Division of Cardiology, Rush University Medical Center, Chicago, Illinois; Department of Medicine, Fairview Hospital, Cleveland, Ohio.

Abstract

BACKGROUND:

In patients with nonvalvular atrial fibrillation (NVAF), the impact of left ventricular diastolic function on the risk for left atrial appendage (LAA) thrombus has not been prospectively studied.

METHODS:

At two academic medical centers, patients with NVAF were prospectively enrolled to undergo investigational transthoracic echocardiography immediately before clinically indicated transesophageal echocardiography. Mitral inflow E velocity and tissue Doppler septal and lateral mitral annulus velocities (e') were measured, and E/e' ratios were calculated.

RESULTS:

Among 266 subjects (mean age, 65 years; 32% women), 17 (6.4%) had LAA thrombus. Patients with LAA thrombus had a higher mean CHA2DS2-VASc score (4.6 ± 1.7 vs 3.0 ± 1.8, P < .001), a higher mean lateral E/e' ratio (19.4 ± 10.1 vs 10.2 ± 5.6, P < .001), and a lower mean lateral e' velocity (7.0 ± 3.2 vs 10.4 ± 3.7 cm/sec, P = .001). There was a good discriminative capacity for E/e' (area under the curve, 0.83; P < .001) and e' velocity (area under the curve, 0.76; P = .001). None of the patients with normal E/e' ratios or normal e' velocities had LAA thrombus. Both E/e' (odds ratio, 1.13 per point; 95% CI, 1.06-1.20; P < .001) and e' velocity (odds ratio, 0.76 per 1 cm/sec; 95% CI, 0.63-0.92; P = .005) provided independent and incremental predictive value beyond the CHA2DS2-VASc score; however, E/e' provided greater incremental value than e' velocity (P = .036). Analyses using septal and averaged E/e' and septal e' velocity yielded similar results. Diastolic function parameters were also associated with the presence and intensity of left atrial spontaneous echo contrast, a precursor of LAA thrombus.

CONCLUSIONS:

This prospective and concomitant evaluation of diastolic function and LAA thrombus in patients with NVAF demonstrates that E/e' ratio and e' velocity are associated with LAA thrombus, independent of CHA2DS2-VASc score, and may play a role in identifying patients at low risk for LAA thrombus. These data suggest that diastolic function assessment may improve stroke prediction in patients with NVAF.

KEYWORDS:

Atrial fibrillation; Diastolic function; Echocardiography; Left atrial appendage thrombus; Spontaneous echocardiographic contrast

PMID:
27021354
DOI:
10.1016/j.echo.2016.01.014
[Indexed for MEDLINE]

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