Left atrial appendage dysfunction in acute cerebral embolism patients with sinus rhythm: correlation with pulse wave tissue Doppler imaging

Abstract

To evaluate left atrial appendage (LAA) dysfunction using left atrial pulse-wave tissue Doppler imaging (PW-TDI) in acute cerebral embolism (ACE) patients with sinus rhythm (SR), transthoracic (TTE) and transesophageal echocardiograhy (TEE) were performed in 60 consecutive patients with SR without obvious left ventricular dysfunction within 2 weeks after ACE. Two groups were identified: LAA dysfunction [LAA emptying peak flow velocity (LAA-eV) <0.55 m/s, n = 20, age 65 ± 10 years] and without LAA dysfunction (LAA-eV ≥ 0.55 m/s, n = 40, age 64 ± 10 years) on TEE. Left atrial wall motion velocity (WMV) was obtained from PW-TDI, with the sample volume placed at the left atrial anterior wall adjacent to ascending aortic inferior wall from the long axis view on TTE. WMVs showed triphasic waves: after the P wave (La') during systole (Ls'), and during early diastole. La' and Ls' were significantly lower in the group with versus without LAA dysfunction (4.9 ± 1.4 vs. 7.7 ± 1.8 cm/s, p < 0.0001; 5.3 ± 2.0 vs. 6.7 ± 1.9 cm/s, p < 0.001, respectively) and prevalence of paroxysmal atrial fibrillation, left atrial volume index, and serum levels of brain natriuretic peptide were significantly higher (60 vs. 15 %, p < 0.001; 32 ± 13 vs. 24 ± 13 ml/m(2), p < 0.05; 174 ± 279 vs. 48 ± 68 pg/ml, p < 0.01, respectively). La' was an independent predictor of LAA dysfunction (OR 0.380, 95 % CI 0.156-0.925, p < 0.05), and was significantly correlated with LAA-eV (r = 0.594, p < 0.0001) and LAA fractional area change (r = 0.682, p < 0.0001). The optimal cut-off value for LAA-eV < 0.55 m/s was 5.5 cm/s (sensitivity 83 %, specificity 88 %). La' is a useful and convenient strong predictor of LAA dysfunction in ACE patients with SR.

Left atrial appendage orifice area and morphology is closely associated with flow velocity in patients with nonvalvular atrial fibrillation

“…The LAA is a finger-like extension originating from the main body of LA [ 17 ]. It has active systolic and diastolic functions, and its mechanical dysfunction may lead to blood flow stagnation and thrombosis [ 18 ]. At present, the LAAFV measured by TEE is the most commonly used method to evaluate the mechanical function of the LAA.…”

Left Atrial Appendage Orifice Area and Morphology is Closely Associated with Flow Velocity in Patients with Nonvalvular Atrial Fibrillation

“…The left atrial appendage is a nger-like extension originating from the main body of LA [16]. It has active systolic and diastolic functions, and its mechanical dysfunction may lead to blood ow stagnation and thrombosis [17]. At present, the LAAFV measured by TEE is the most commonly used method to evaluate the mechanical function of the LAA.…”