Influence of Left Ventricular Diastole on Left Atrial Appendage Blood Flow in Patients with Nonrheumatic Atrial Fibrillation

Lin, Jing; Hsu, Kwan-Lih; Hwang, Juey-Jen; Tseng, Yung‐Zu

doi:10.1159/000177420

Cited by 11 publications

(10 citation statements)

References 16 publications

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“…We found a higher prevalence of SEC in patients with impaired systolic left ventricular function. This nding is consistent with previous investigations that described a reduction in LAA ow velocity, higher rates of SEC, 13 and subsequent thromboembolism 26 in patients with systolic left ventricular dysfunction.…”

Section: Factors Related To the Occurrence Of Secsupporting

confidence: 92%

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Left Atrial Appendage Function and Pulmonary Venous Flow in Patients with Nonrheumatic Atrial Fibrillation and Their Relation to Spontaneous Echo Contrast

et al. 2002

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This study analyzed the relation between frequency of left atrial appendage (LAA) contractions, pulmonary venous flow (PVF) parameters, and spontaneous echo contrast (SEC). Thirty-six patients (22 male, 14 female, mean age 61 plus minus 11 years) with nonrheumatic atrial fibrillation undergoing transesophageal echocardiography were studied. Doppler flow was obtained from both the LAA and the left upper pulmonary vein. Fourier analysis was applied to the LAA signal that exhibited the frequency of LAA contractions. LAA emptying velocity and PVF parameters were determined. There was no relation between velocity and frequency of LAA flow (r = 0.256, P = ns). Among LAA and PVF parameters, patients with left atrial SEC (n = 17) had a lower LAA velocity (16.8 +/- 10.8 cm/sec vs 35.6 +/- 13.2 cm/sec, P < 0.001), a larger LAA area (4.8 +/- 2.2 cm(2) vs 3.0 +/- 1.3 cm(2), P = 0.008), and a reduced systolic velocity time integral of PVF (3.4 +/- 2.2 cm vs 5.4 +/- 2.2 cm, P = 0.017) when compared with patients without SEC. Frequency of LAA contractions was similar between both groups (6.8 +/- 0.4 Hz vs 6.8 +/- 1.0 Hz, P = ns). In conclusion, the rate of LAA contraction does not correlate with LAA flow velocity and SEC. A low left atrial flow expressed by low LAA flow velocity and a reduction in systolic PVF is a major hemodynamic determinant for the occurrence of SEC.

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Section: Factors Related To the Occurrence Of Secsupporting

confidence: 92%

“…A reduction in systolic left ventricular function contributed to the development of SEC. While LAA 1-3, 5 and left ventricular parameters 13 have been studied previously, the association between SEC and reduced systolic PVF represents a new contribution.…”

Section: Discussionmentioning

confidence: 99%

Left Atrial Appendage Function and Pulmonary Venous Flow in Patients with Nonrheumatic Atrial Fibrillation and Their Relation to Spontaneous Echo Contrast

et al. 2002

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“…Age, heart rate and rhythm, LA and LAA size, LA and LAA mechanical function, load, and LV systolic and diastolic function have been shown to determine LAA flow velocities in humans. 9,[18][19][20][38][39][40][41][42][43] However, a recent study of 43 normal cats did not identify any effect of such variables on LAA max . 14 In the present study, age and heart rate were not found to be independent determinants of LAA max .…”

Section: Discussionmentioning

confidence: 99%

Assessment of Left Atrial Appendage Flow Velocity and its Relation to Spontaneous Echocardiographic Contrast in 89 Cats with Myocardial Disease

Schober

Maerz

2006

Veterinary Internal Medicne

130

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The hypotheses of this prospective study were that (1) left atrial appendage (LAA) blood flow velocities can be recorded in cats with myocardial disease by transthoracic Doppler echocardiography, (2) LA enlargement, LA mechanical dysfunction, and left ventricular (LV) diastolic abnormalities are associated with decreased LAA flow velocities, and (3) low LAA flow velocities predict the appearance of spontaneous echocardiographic contrast in cats with cardiomyopathy. Transthoracic 2-dimensional, M-mode, and Doppler echocardiographic studies were performed in 89 cats with hypertrophic, restrictive, dilated, or unclassified cardiomyopathy or with hyperthyroid heart disease. Maximal LAA flow velocity (LAAmax) was decreased (P < .001) in cats with cardiomyopathy (median, 0.28 m/s; range, 0.08-1.35) compared to normal cats. Associated with decreased LAA flow velocities were increased LA size, decreased LA function, increased severity of LV diastolic dysfunction, and the presence of congestive heart failure. Multivariate logistic regression analysis detected an LAAmax <0.20 m/s as the only independent variable to predict LA spontaneous echocardiographic contrast (odds ratio, 30.1; 95% confidence interval [CI], 4.1 222.3; P < .001). Receiver operating characteristic analysis performed to predict spontaneous echocardiographic contrast indicated an area under the curve of 0.88 (95% CI, 0.80-0.95; P < .001) with sensitivities of 100 and 74% and specificities of 69 and 83% for LAAmax <0.25 and <0.20 m/s, respectively. Thus, low LAA flow velocities identified a subgroup of patients at increased risk of spontaneous echocardiographic contrast and possible thromboembolism. These findings may have important clinical implications for anticoagulation therapy and prognostication in cats with cardiomyopathy.

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“…2-4 Ventricular function is known to be a major determinant of both LAA flow and thromboembolic risk. [10][11][12][13] As heart rate increases, diastolic filling time proportionately decreases to a far greater degree than ventricular systole and is very short when heart rate is rapid. 14 15 The relation of LAA and LV function has been studied in most detail in patients who were in sinus rhythm.…”

Section: Discussionmentioning

confidence: 99%

Effects of ventricular rate and regularity on the velocity and magnitude of left atrial appendage flow in atrial fibrillation

Obel

Luddington²,

Maarouf³

et al. 2005

Heart

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Objective: To prospectively determine whether ventricular rate and regularity are significant determinants of the velocity and magnitude of left atrial appendage (LAA) flow. Design and patients: 12 patients with atrial fibrillation (AF), high degree atrioventricular block, and indwelling permanent pacemakers were studied. Setting: Cardiology department of a tertiary referral centre. Interventions: Pacing was triggered by an external programmable transcutaneous device. Patients were paced at 60, 120, and 150 beats/min in both regular and irregular rhythm. LAA flow velocity and magnitude were assessed with transoesophageal Doppler echocardiography. Main outcome measures: Peak and mean LAA inflow and outflow velocity, and time-velocity interval (TVI) of LAA flow. Results: Increasing ventricular rate was associated with significantly lower peak inflow (p , 0.01), peak outflow (p , 0.05), mean inflow (p , 0.01), and mean outflow (p , 0.05) velocities and with a lower TVI of LAA filling and emptying velocities (p , 0.01). This effect was noted at rates of 60 beats/min compared with both 120 and 150 beats/min. At a pacing rate of 120 beats/min there was a significantly higher total TVI when pacing at a regular than at an irregular rhythm (40.16 (14.6) cm v 30.74 (10.9) cm, p , 0.05). Conclusions: In this study, LAA filling velocities in patients in AF were significantly influenced by paced ventricular rate and to a much lesser extent ventricular rhythm. These results suggest that rapid ventricular rates may predispose to stasis in the LAA in AF.A trial fibrillation (AF) is associated with an increased risk of systemic embolism and stroke, even in the absence of valvar heart disease.1 The majority of these events result from thrombus formation within the left atrium, in particular the left atrial appendage (LAA). LAA flow has been shown to be related to left ventricular (LV) filling and loading, 5 which in turn are related to ventricular rate and regularity of rhythm.6 7 Furthermore, the LAA lies within the confines of the pericardium close to the LV free wall. The purpose of this study was to prospectively determine, in a controlled manner, whether ventricular rate and regularity influence the velocity and magnitude of LAA flow. PATIENTS AND METHODS PatientsThe study group comprised 12 patients aged 43-74 years with high degree atrioventricular (AV) block who were in AF. Five patients had undergone AV nodal ablation, most recently 16 months before the study. All patients had an indwelling permanent pacemaker with the facility to be programmed to triggered (VVT) mode. Full ethical approval was obtained for the study and all patients gave informed written consent. Potential study participants were identified by reviewing records from our pacemaker follow up clinic and records of AV nodal ablation procedures. Patients with permanent pacemakers implanted for high degree AV block who had a history of AF were identified. Patients were excluded if they had significant mitral valve disease; if they were not able to safely tole...

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Influence of Left Ventricular Diastole on Left Atrial Appendage Blood Flow in Patients with Nonrheumatic Atrial Fibrillation

Cited by 11 publications

References 16 publications

Left Atrial Appendage Function and Pulmonary Venous Flow in Patients with Nonrheumatic Atrial Fibrillation and Their Relation to Spontaneous Echo Contrast

Left Atrial Appendage Function and Pulmonary Venous Flow in Patients with Nonrheumatic Atrial Fibrillation and Their Relation to Spontaneous Echo Contrast

Assessment of Left Atrial Appendage Flow Velocity and its Relation to Spontaneous Echocardiographic Contrast in 89 Cats with Myocardial Disease

Effects of ventricular rate and regularity on the velocity and magnitude of left atrial appendage flow in atrial fibrillation

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