Left Atrial Appendage Dysfunction: A Cause of Thrombosis? Evidence by Transesophageal Echocardiography-Doppler Studies

Pozzoli, Massimo; Febo, Oreste; Torbicki, Adam; Tramarin, Roberto; Calsamiglia, Giuseppe; Cobelli, Franco; Specchia, Giuśeppe; Roelandt, J. R. T. C.

doi:10.1016/s0894-7317(14)80376-3

Cited by 124 publications

(57 citation statements)

References 5 publications

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“…Even under warfarin treatment, patients with an LA thrombus (group 2) had lower LAA flow velocity ( Figure 1A) and LVEF ( Figure 1C Many reports have found a strong relationship between LAA flow velocity and LA thrombus formation. 9,14,15) In our study, the maximum velocity of LAA flow in patients with LA thrombus not treated with warfarin (group 1) was 39 cm/s.…”

Section: Resultsmentioning

confidence: 50%

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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Section: Resultsmentioning

confidence: 50%

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

Watanabe

Yamashita

2014

Int. Heart J.

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“…(Jpn Heart J 2000; 41: 451-462) Key words: Right atrial appendage function, Atrial fibrillation, Transesophageal echocardiography TRANSESOPHAGEAL echocardiography (TEE) has been shown to be a useful technique for assessing left atrial appendage (LAA) function by measuring LAA flow velocities. [1][2][3][4][5] These studies have highlighted the importance of LAA function in patients with atrial fibrillation (AF). Recently, right atrial appendage (RAA) thrombi [6][7][8][9] and depressed RAA function 10) have been reported in patients with AF.…”

Section: Discussionmentioning

confidence: 99%

Right Atrial Appendage Function in Patients with Chronic Nonvalvular Atrial Fibrillation.

Bilge¹,

Eryonucu²,

Güler³

et al. 2000

Jpn Heart J

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SUMMARYTo assess right atrial appendage (RAA) flow and its possible relationship to left atrial appendage (LAA) flow in chronic nonvalvular atrial fibrillation (AF), transesophageal echocardiography (TEE) was performed in 26 patients with chronic nonvalvular AF (group I). For the purpose of comparison, an additional group of 27 patients with chronic valvular AF due to mitral stenosis (group II) was analyzed. The clinically estimated duration of AF in group I was significantly longer than that of group II (8.7 ± 3.4 versus 2.7 ± 1.1 years). Although right atrial size and RAA maximal area were larger in group I than those in group II, left atrial size was larger in group II than that in group I. Group II had larger LAA maximal areas than group I, but this difference did not reach statistical significance. The two groups were not different with respect to the RAA or LAA emptying velocities. Significant correlations were observed between echocardiographic parameters of the two atria in patients with nonvalvular AF (r range, 0.4 to 0.7). In contrast, in patients with valvular AF, no correlation was observed between the echocardiographic parameters of the two atria (appendage emptying velocity, r = 0.38, p = 0.051; atrial size, r = − 0.03, p = 0.89; maximal appendage area, r = 0.07, p = 0.75, respectively). There were no significant differences in the presence of right and left atrial spontaneous echo contrast and thrombus between the groups. All of the right and left atrial thrombi were confined to their respective appendages and were found in the atria with spentaneous echo contrast. Both RAA and LAA thrombi were present in one patient. In conclusion, our findings suggest that AF could affect both atria equally in nonvalvular AF, in contrast to valvular AF. Therefore, the assessment of RAA function as well as LAA may be important in patients with chronic nonvalvular AF. (Jpn Heart J 2000; 41: 451-462)

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“…[32][33][34] Recent guidelines recommend antithrombotic therapy even for low-risk patients with a CHA2DS2-VASc score of 1. 33) Many reports have found a strong relationship between LAA-FV and LA thrombus formation, 7,35,36) and less than 20 cm/s of LAA-FV represents a risk of thrombus formation in LA. 9) In the present study, LAA-FV obtained by TEE was significantly associated with the CHA2DS2-VASc score.…”

Section: Discussionmentioning

confidence: 99%

Left Atrial Remodeling Assessed by Transthoracic Echocardiography Predicts Left Atrial Appendage Flow Velocity in Patients With Paroxysmal Atrial Fibrillation

et al. 2016

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SummaryAtrial fibrillation (AF) is associated with an increased risk of stroke and other thromboembolic events. Left atrial (LA) thrombus formation is closely related to LA dysfunction, particularly to decreased LA appendage flow velocity (LAA-FV) in patients with AF. We estimated LAA-FV using parameters noninvasively obtained by transthoracic echocardiography (TTE) in patients with paroxysmal AF.Echocardiographic and clinical parameters were assessed in 190 patients with nonvalvular paroxysmal AF showing sinus heart rhythm during transesophageal echocardiography (TEE) and TTE.LAA-FV (60 ± 22 cm/s) significantly correlated with the time interval between the initiation of the P-wave on ECG and that of the A-wave of transmitral flow on TTE (PA-TMF, correlation coefficient, −0.32; P < 0.001), LA dimension (LAD, −0.31; P < 0.001), septal a' velocity of tissue Doppler imaging (TDI, 0.35; P < 0.001), E/e' ratio (−0.28, P < 0.001), E velocity of transmitral flow (−0.20, P = 0.008), E/A ratio of transmitral flow (−0.18, P = 0.02), CHA2DS2-VASc score (−0.15, P = 0.04), and BNP plasma level (−0.32, P = 0.002). Multivariate analysis revealed that PA-TMF (standardized partial regression coefficient, −0.17; P = 0.03), a' velocity (0.24, P = 0.004), and LAD (−0.20, P = 0.01) were independent predictors of LAA-FV (multiple correlation coefficient R, 0.44; P < 0.001).Parameters of atrial remodeling, ie, decreased a' velocity, increased LAD, and PA-TMF during sinus rhythm may be useful predictors of LA blood stasis in patients with nonvalvular PAF. LAA-FV can be estimated using these TTE parameters instead of TEE. (Int Heart J 2016; 57: 177-182)

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Left Atrial Appendage Dysfunction: A Cause of Thrombosis? Evidence by Transesophageal Echocardiography-Doppler Studies

Cited by 124 publications

References 5 publications

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

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

Right Atrial Appendage Function in Patients with Chronic Nonvalvular Atrial Fibrillation.

Left Atrial Remodeling Assessed by Transthoracic Echocardiography Predicts Left Atrial Appendage Flow Velocity in Patients With Paroxysmal Atrial Fibrillation

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