Influence of left atrial function on Doppler transmitral and pulmonary venous flow patterns in dilated and hypertrophic cardiomyopathy: Evaluation of left atrial appendage function by transesophageal echocardiography

Ito, Takahide; Suwa, Michihiro; Hirota, Yuzo; Otake, Yoshiaki; Moriguchi, Ayaka; Kawamura, Keishiro

doi:10.1016/s0002-8703(96)90060-5

Cited by 46 publications

(27 citation statements)

References 30 publications

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“…6,7,12,13 Several investigators have reported that AF patients with a low LAA blood flow velocity (reflecting impaired left atrial (LA) function) have a higher risk of thromboembolism than patients with an appendage flow >20 cm/s. 8,[12][13][14][15][16] In addition, the thrombin level is increased and platelet activation occurs in patients with either valvular or non-valvular AF. 17,18 Abnormal values of these markers might not appear however, until thrombin activation has commenced, and more importantly, such abnormal values might not necessarily reflect changes of cardiac origin.…”

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confidence: 99%

Plasma Brain Natriuretic Peptide Levels Indicating Thromboembolism in Very Elderly Patients With Non-Valvular Atrial Fibrillation

Watanabe

Shizuka

Koyama

et al. 2007

Circ J

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trial fibrillation (AF) is a sustained arrhythmia that is most commonly found among persons in their 60 s, and its incidence is reported to be 2-4% of this generation. In people >75 years old, the incidence of AF has been reported to increase to 11.6%. [1][2][3] Thromboembolism is an important complication of AF that causes deterioration in the quality of life, 4,5 but the most appropriate candidates for anticoagulant therapy among patients with AF remain a matter of debate.Transesophageal echocardiography (TEE) is a useful clinical tool for identifying actual thrombi and for visualizing spontaneous echo contrast (SEC), a change which might predispose patients to develop atrial thrombosis. [6][7][8][9][10][11][12] The left atrial appendage (LAA) flow velocity measured by TEE has been used as a parameter of LAA function. 6,7,12,13 Several investigators have reported that AF patients with a low LAA blood flow velocity (reflecting impaired left atrial (LA) function) have a higher risk of thromboembolism than patients with an appendage flow >20 cm/s. 8,[12][13][14][15][16] In addition, the thrombin level is increased and platelet activation occurs in patients with either valvular or non-valvular AF. 17,18 Abnormal values of these markers might not appear however, until thrombin activation has commenced, and more importantly, such abnormal values might not necessarily reflect changes of cardiac origin.The level of brain natriuretic polypeptide (BNP) is increased in patients with various heart diseases, such as congestive heart failure, 19,20 dilated cardiomyopathy, 21 hypertrophic cardiomyopathy, hypertensive heart disease, 22 and lone AF. 23,24 Contrary to earlier theories that BNP is mainly secreted by the ventricular myocardium, 21,25,26 it was reported recently that the left atrium (not the left ventricle) is the main source of BNP in patients with AF. 23 The major findings of that study were : (1) patients with AF have significantly higher plasma BNP levels than control subjects; (2) a significant increase of BNP occurs between the coronary sinus (reflecting ventricular secretion) and the anterior interventricular vein (reflecting atrial secretion); and (3) there is a significant decrease of both plasma BNP and atrial BNP production after cardioversion of AF to sinus rhythm. 23,24 In the present study, we examined whether plasma BNP levels are higher in very elderly patients with clinical evidence of thromboembolism than in very elderly patients without this complication, and whether plasma BNP levels are correlated with LA function as represented by LAA flow. Methods PatientsWe studied 74 patients (38 men and 36 women aged, 75-96 years; mean, 82 years) with ECG-documented AF who were referred to our department for examination of cerebral vascular diseases. All patients underwent transthoracic and TEE, and then were classified into 2 groups.Circ J 2007; 71: 1446 -1451 (Received February 6, 2007 revised manuscript received May 22, 2007; accepted May 23, 2007 Background Assessment of left atrial (LA) function b...

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confidence: 99%

Plasma Brain Natriuretic Peptide Levels Indicating Thromboembolism in Very Elderly Patients With Non-Valvular Atrial Fibrillation

Watanabe

Shizuka

Koyama

et al. 2007

Circ J

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“…6,7,12,13 Several investigators have reported that patients with AF who have a low appendage blood flow velocity, reflecting impaired LAA function, have a higher risk of thromboembolism than patients with an appendage flow Ͼ20 cm/s. 8,[12][13][14][15][16] On the other hand, a biochemical approach to circulating blood enables us to assume thrombin activation and platelet enhancement in patients with either valvular or nonvalvular AF. 17,18 Abnormal values for these biochemical markers may not appear, however, until thrombin is actually being activated, and more important, these abnormal values may not necessarily be of cardiac origin.…”

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confidence: 99%

High Plasma Brain Natriuretic Polypeptide Level as a Marker of Risk for Thromboembolism in Patients With Nonvalvular Atrial Fibrillation

Shimizu

Murakami

Inoue

et al. 2002

Stroke

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Background and Purpose-Assessment of left atrial appendage (LAA) function with transesophageal echocardiography is useful for detecting patients at high risk for thromboembolism as a result of atrial fibrillation (AF). A recent study reported that the atrium is the main source of brain natriuretic polypeptide (BNP) in AF patients without overt heart failure. The purpose of this study was to assess a possible relationship between LAA function and plasma BNP levels in nonvalvular AF. Methods-Thirty-four consecutive patients with chronic nonvalvular AF (age, 69Ϯ9 years) underwent transesophageal echocardiography and plasma BNP measurement. Thirteen patients with a history of thromboembolism or echocardiographic evidence of thrombus (E ϩ group) were compared with 21 AF patients without complications (EϪ group). Results-The Eϩ group patients demonstrated greater impairment of LAA velocity and higher plasma BNP levels than the EϪ group patients (LAA velocity: 12Ϯ6 versus 31Ϯ17 cm/s, PϽ0.05; plasma BNP: 126Ϯ53 versus 86Ϯ45 ng/L, PϽ0.05). Overall analysis of the continuous variables with multiple logistic regression analysis revealed that BNP was a significant predictor of thromboembolism. There was a weak but significant negative correlation between plasma BNP levels and LAA flow velocity (rϭ0.38, PϽ0.05). No intergroup difference in plasma atrial natriuretic polypeptide levels was found. Conclusions-The present data suggest the usefulness of measuring plasma BNP levels, which may reflect augmented atrial secretion of BNP from the impaired atrial myocardium, in detecting patients at high risk for thromboembolic complications in nonvalvular AF.

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“…Most cardiologists believe that TTE is insufficient in the evaluation of LAA morphology, size, and function for establishing its embolic potential (Mügge et al 1990;Heppell et al 1997), mainly because previous studies using fundamental imaging technology have demonstrated unsatisfactory sensitivity to detect thrombus (Shrestha et al 1981;Otto 2002). On the other hand, TEE has been considered the gold standard for LAA assessment (Pop et al 1990;Lee et al 1991;Pearson et al 1991;Mügge et al 1994;Santiago et al 1994;Ito et al 1996), as it allows accurate evaluation of this structure in virtually all patients. However, this technique is semiinvasive, uncomfortable, costly, and carries its own risks (Daniel et al 1991).…”

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confidence: 99%

Transthoracic Echocardiographic Predictors of the Left Atrial Appendage Contraction Velocity in Stroke Patients with Sinus Rhythm

Uslu

Nurkalem

Orhan

et al. 2006

Tohoku J. Exp. Med.

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Systemic embolization is a potential complication in patients with thrombi situated in the left atrium and particularly, in the left atrial appendage (LAA). Reduced LAA contraction velocities, determined by the transesophageal echocardiography (TEE), are associated with increased risk of LAA spontaneous echocontrast and thrombus formation, and a history of systemic embolism. However, TEE remains a semi-invasive procedure, limiting its serial application as a screening tool. Therefore, it is desirable to obtain information regarding LAA function by transthoracic echocardiography in patients having cardioembolic stroke. The present study was designed to investigate various echocardiographic variables for patients with stroke to predict LAA dysfunction, reflected as reduced LAA contraction velocity. We studied a total of 61 patients with newly diagnosed acute embolic stroke (42 patients) and transient ischemic attack (19 patients). Computerized tomographic scanning was performed for the diagnosis of embolic stroke. Left atrial functional parameters determined by transthoracic echocardiography, such as left atrial active emptying fraction and acceleration slope of mitral inflow A wave, had significant correlations with the LAA contraction velocity (r = 0.57, p < 0.001; r = 0.54, p < 0.001, respectively). Left atrial volume index, left atrial active emptying volume and left atrial fractional shortening were also correlated with LAA contraction velocity (r = −0.44, p < 0.001; r = 0.38, p = 0.003; r = 0.37, p = 0.004, respectively). In conclusion, transthoracic echocardiography can provide valuable and reliable information about the LAA contraction velocity in stroke patients with sinus rhythm. This finding gives new insights for the appropriate strategy in the evaluation of an acute ischemic stroke. left atrial appendage contraction velocity; transthoracic echocardiography; transesophageal echocardiography

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Influence of left atrial function on Doppler transmitral and pulmonary venous flow patterns in dilated and hypertrophic cardiomyopathy: Evaluation of left atrial appendage function by transesophageal echocardiography

Cited by 46 publications

References 30 publications

Plasma Brain Natriuretic Peptide Levels Indicating Thromboembolism in Very Elderly Patients With Non-Valvular Atrial Fibrillation

Plasma Brain Natriuretic Peptide Levels Indicating Thromboembolism in Very Elderly Patients With Non-Valvular Atrial Fibrillation

High Plasma Brain Natriuretic Polypeptide Level as a Marker of Risk for Thromboembolism in Patients With Nonvalvular Atrial Fibrillation

Transthoracic Echocardiographic Predictors of the Left Atrial Appendage Contraction Velocity in Stroke Patients with Sinus Rhythm

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