Assessment of left atrial appendage function by transesophageal echocardiography. Implications for the development of thrombus.

Pollick, Charles; Taylor, D.

doi:10.1161/01.cir.84.1.223

Cited by 433 publications

(276 citation statements)

References 12 publications

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“…In this context, studies utilizing TEE have shown that decreased LAA peak flow velocities are independent risk factors for stroke in AF. 11,25 Furthermore, the presence of spontaneous echo contrast, a marker of reduced blood flow velocity or stasis, has been shown to be an independent predictor for thromboembolism. 12,26 In this study, we used 4D flow CMR for the assessment of LA blood flow velocities, which has several potential advantages compared with TEE including full volumetric coverage of the LA, quantification of the complete time-resolved, three-directional velocity field inside the LA, and no need for semi-invasive oesophageal intubation.…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional left atrial blood flow characteristics in patients with atrial fibrillation assessed by 4D flow CMR

Lee

Markl

et al. 2015

Eur Heart J Cardiovasc Imaging

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AimsTo apply 4D flow cardiac magnetic resonance (CMR) for the volumetric measurement of 3D left atrial (LA) blood flow to evaluate its potential to detect altered LA flow in patients with atrial fibrillation (AF) and to investigate associations of changes in systolic and diastolic LA flow with the current clinical risk score (CHA 2 DS 2 -VASc) used for the assessment of thromboembolic risk in AF. Methods and results4D flow CMR was performed in 40 patients with a history of AF (in sinus rhythm during CMR scan, age ¼ 61 + 11 years), 20 age-appropriate controls (59 + 7 years), and 10 young healthy volunteers (24 + 2 years) to measure in vivo time-resolved 3D LA blood flow. LA velocities were characterized with respect to atrial function and timing by calculating normalized LA flow velocity histograms during ventricular systole, early diastole, mid-late diastole, and the entire cardiac cycle. Mean, median, and peak LA velocity steadily decreased when comparing young volunteers, age-appropriate controls, and AF patients by 10 -44% and 8 -26% for early diastole and the entire cardiac cycle, respectively (P , 0.01 for all comparisons except median velocity for young vs. older volunteers and peak velocity for older volunteers and AF patients). There were moderate but significant inverse relationships between increased CHA 2 DS 2 -VASc score and reduced mean LA velocity (early diastole: r ¼ 20.37, P , 0.001; entire RR-interval: r ¼ 20.33, P ¼ 0.005), median LA velocity (r ¼ 20.33, P ¼ 0.003; r ¼ 20.25, P ¼ 0.017), and peak velocity (r ¼ 20.36, P ¼ 0.001; r ¼ 20.45, P , 0.001). LA flow indices also correlated significantly with age and LA volume (R 2 ¼ 0.44-0.62, P , 0.001), but not with left ventricular ejection fraction. ConclusionLeft atrial 4D flow CMR demonstrated significantly reduced LA blood flow velocities in patients with AF. Further study is needed to determine whether these measures can improve upon the CHA 2 DS 2 -VASc score for stroke risk prediction and enhance individual decisions on anticoagulation in patients with AF.--

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Section: Discussionmentioning

confidence: 99%

Three-dimensional left atrial blood flow characteristics in patients with atrial fibrillation assessed by 4D flow CMR

Lee

Markl

et al. 2015

Eur Heart J Cardiovasc Imaging

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“…In patients with AF, the LAA max and LAA min were visually determined by two observers independent of the ECG and measurements. The LAA emptying fraction (LAA-EF) was calculated by the method described by Pollick and Taylor as ([LAA max -LAA min ]/ /LAA max × 100%) [3]. 2.…”

Section: Teementioning

confidence: 99%

“…LAA function was reported to be correlated with LAA stasis [3]. Considering the structural integrity and functional consistency of LA and LAA, there should be a relation between LA function and LAA stasis.…”

Section: Introductionmentioning

confidence: 98%

The value of left atrial strain and strain rate in predicting left atrial appendage stasis in patients with nonvalvular atrial fibrillation

Zhu

Wang

et al. 2018

Cardiol J.

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“…6,7) Doppler TEE measurements of blood flow velocity in the LA appendage (LAA) and the presence of LA spontaneous echocardiographic contrast (LASEC) have been used to assess the severity of blood stasis, a risk factor for thrombus formation and stroke. 7,8) Previous reports have shown that dense LASEC, decreased LAA flow velocity, and complex aortic plaques on TEE are independent risk factors for subsequent thromboembolic events. [9][10][11] In fact, Takashima, et al reported that these TEE findings were stronger predictors of ischemic stroke than the CHADS2 score in patients with NVAF.…”

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confidence: 99%

Blood Stasis Secondary to Heart Failure Forms Warfarin-Resistant Left Atrial Thrombus

Watanabe

Yamashita

2014

Int. Heart J.

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SummaryAnticoagulants such as warfarin are recommended for patients with atrial fibrillation (AF) to decrease stroke risk associated with thrombus formation in the left atrium (LA). In a subgroup of patients, however, warfarin is unable to prevent LA thrombus formation at therapeutic doses. This study characterized the clinical and echocardiographic features of patients having warfarin-resistant LA thrombus.Of the 1364 nonvalvular AF patients examined by transesophageal echocardiography, 431 received warfarin. A total of 10 patients (2.3% of warfarin-treated patients) exhibited LA thrombus formation even during warfarin treatment at a dose and duration sufficient for increasing the prothrombin time-international normalized ratio (PT-INR) to the therapeutic range for ≥ 30 days. Categorical regression analysis revealed that decreased LA appendage (LAA) flow velocity, greater LA spontaneous echocardiographic contrast (LASEC), and lower left ventricular ejection fraction (LVEF) significantly contributed to residual LA thrombus (P < 0.05 for all). Receiver operating characteristic (ROC) curve analysis indicated that higher right ventricular systolic pressure, which suggests LA pressure (area under curve, 0.85), LV mass index (0.81), and LA dimension (0.68), as well as lower LAA flow velocity (0.92) and LVEF (0.91) predicted warfarinresistant LA thrombus formation (all P < 0.05).These results suggest that blood stasis secondary to heart failure contributes to the formation of warfarin-resistant LA thrombus. We propose that therapies to increase LVEF should be administered together with warfarin for AF patients with heart failure to decrease stroke risk. (Int Heart J 2014; 55: 506-511)

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Assessment of left atrial appendage function by transesophageal echocardiography. Implications for the development of thrombus.

Abstract: We conclude that the LAA has a characteristic pattern of emptying in sinus rhythm. LAA thrombus formation in sinus rhythm and atrial fibrillation is associated with both poor LAA contraction and LAA dilation.

Cited by 433 publications

References 12 publications

Three-dimensional left atrial blood flow characteristics in patients with atrial fibrillation assessed by 4D flow CMR

Three-dimensional left atrial blood flow characteristics in patients with atrial fibrillation assessed by 4D flow CMR

The value of left atrial strain and strain rate in predicting left atrial appendage stasis in patients with nonvalvular atrial fibrillation

Blood Stasis Secondary to Heart Failure Forms Warfarin-Resistant Left Atrial Thrombus

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