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

Doukky, Rami; Garcia‐Sayan, Enrique; Patel, Mita; Pant, Rojina; Wassouf, Marwan; Shah, Saurabh; D’Silva, Oliver; Kehoe, Richard F.

doi:10.1016/j.echo.2016.01.014

Cited by 38 publications

(36 citation statements)

References 27 publications

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“…The authors found that E:e′ ratio and lateral e′ were the strongest predictors of LAA thrombus after adjustment for anticoagulation status and the CHA 2 DS 2 ‐VAS c score. These findings were recently confirmed by the same authors in a prospective series with 17 cases of thrombus showing strong ROC discriminatory capacity of both E:e′ ratio and e′ to exclude LAA thrombus independent of CHA 2 DS 2 ‐VAS c …”

Section: Discussionsupporting

confidence: 59%

Average e′ velocity on transthoracic echocardiogram is a novel predictor of left atrial appendage sludge or thrombus in patients with atrial fibrillation

Garshick¹,

Mulliken

Schoenfeld³

et al. 2018

Echocardiography

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Background Studies have demonstrated the value of transthoracic echocardiogram (TTE) diastolic parameters in predicting left atrial appendage (LAA) thrombus; however, these studies have been small. We aim to clarify the relationship between TTE diastolic parameters, in particular average e′, and LAA thrombus or sludge. Methods A case‐control review was conducted of subjects with non‐valvular atrial fibrillation (n = 2263) who had undergone TEE (transesophageal echocardiogram) and had a TTE within 1 year of TEE. Cases of LAA sludge or thrombus were matched to controls by age, sex, left ventricular ejection fraction (LVEF), and anticoagulation status. Results Forty‐three subjects (mean age 73 ± 12, 65% male, LVEF 47%, 44% on anticoagulation) with LAA sludge or thrombus were identified. Compared to matched controls, average TTE e′ (7.3 ± 2.1 cm/s vs 8.7 ± 2.1 cm/s, P < 0.001) and the E:e′ ratio (15 ± 7 cm/s vs 12 ± 5 cm/s; P = 0.005) were significant predictors of LAA sludge or thrombus. Average TTE e′ value of >11 cm/s had 100% sensitivity for ruling out LAA sludge or thrombus. Conclusion In individuals with atrial fibrillation, average e′ >11 cm/s on TTE is a promising independent predictor of the absence of LAA sludge or thrombus on TEE.

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Section: Discussionsupporting

confidence: 59%

Average e′ velocity on transthoracic echocardiogram is a novel predictor of left atrial appendage sludge or thrombus in patients with atrial fibrillation

Garshick¹,

Mulliken

Schoenfeld³

et al. 2018

Echocardiography

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“…A dysfunction in contractility leads to reduced blood flow velocity and aids the development of thrombi . Previous studies established that the presence of LAAT is associated with higher CHADS 2 and CHA 2 DS 2 ‐VASc scores, reduced LVEF, LV diastolic dysfunction, increased iLV mass, iLA volume, B‐type natriuretic peptide level, and restricted motion of the left atrial appendage . Several of these outcomes were also confirmed in the current study.…”

Section: Discussionmentioning

confidence: 99%

Incremental value of left atrial mechanical dispersion over CHA₂DS₂‐VASc score in predicting risk of thrombus formation

et al. 2018

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“…In the recently published guideline, four parameters have been recommended to establish the presence of LV diastolic dysfunction, that is, e′ of septal and LV lateral wall, average E/e′ ratio, LAVi, and peak TR velocity, when E/A ratio is used to grade the severity. Particularly, average E/e′ has been considered as the most reliable echocardiographic parameter to reflect LV filling pressure . However, the Doppler parameters have been shown to be less sensitive to detect alteration of diastolic performance .…”

Section: Discussionmentioning

confidence: 99%

Left ventricular end‐diastolic strain rate recovered in hypothyroidism following levothyroxine replacement therapy: A strain rate imaging study

et al. 2019

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Background This study aimed to explore the impact of overt hypothyroidism on diastolic left ventricular (LV) deformation and the effect of levothyroxine therapy using 2‐dimensional speckle‐tracking echocardiography (STE) strain rate (SR) imaging. Methods Forty‐seven newly diagnosed hypothyroidic patients and 51 controls were prospectively enrolled. All participants underwent comprehensive 2‐dimensional echocardiography. Besides the recently recommended parameters of LV diastolic function, strain imaging for LV systolic global longitudinal strain (GLS), and diastolic SR imaging at isovolumic relaxation period (SRivr), early (SRe) and late (SRa) diastole were assessed. Repeated echocardiography in hypothyroidic patients was made 6 months after the euthyroidic state was achieved. Results Hypothyroidic patients had a lower ejection fraction (EF) than the controls (68.6 ± 5.2% vs 71.5 ± 4.0%, P = 0.002) but all within normal range (57%–80% and 64%–79%, respectively). No difference in the ratio of early mitral flow (E) to early diastolic septal or lateral myocardial motion velocity (e′) was found (both P > 0.05), but significant difference was identified for SRa (0.85 ± 0.17 [/s] vs 1.00 ± 0.17 [/s], P = 0.000) and GLS (−20.8 ± 3.2% vs −23.6 ± 2.3%, P = 0.000). Upon follow‐up, LV SRa (1.01 ± 0.20 [/s], P = 0.99 vs control) normalized when GLS (−21.6 ± 3.1%, P = 0.004 vs control) remained worse than the controls. Conclusion This study demonstrates subtle LV diastolic impairment in untreated hypothyroidic patients using SR imaging, which normalizes with short‐term therapy and predates GLS.

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

Cited by 38 publications

References 27 publications

Average e′ velocity on transthoracic echocardiogram is a novel predictor of left atrial appendage sludge or thrombus in patients with atrial fibrillation

Average e′ velocity on transthoracic echocardiogram is a novel predictor of left atrial appendage sludge or thrombus in patients with atrial fibrillation

Incremental value of left atrial mechanical dispersion over CHA₂DS₂‐VASc score in predicting risk of thrombus formation

Left ventricular end‐diastolic strain rate recovered in hypothyroidism following levothyroxine replacement therapy: A strain rate imaging study

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

Cited by 38 publications

References 27 publications

Average e′ velocity on transthoracic echocardiogram is a novel predictor of left atrial appendage sludge or thrombus in patients with atrial fibrillation

Average e′ velocity on transthoracic echocardiogram is a novel predictor of left atrial appendage sludge or thrombus in patients with atrial fibrillation

Incremental value of left atrial mechanical dispersion over CHA2DS2‐VASc score in predicting risk of thrombus formation

Left ventricular end‐diastolic strain rate recovered in hypothyroidism following levothyroxine replacement therapy: A strain rate imaging study

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Incremental value of left atrial mechanical dispersion over CHA₂DS₂‐VASc score in predicting risk of thrombus formation