Left atrial appendage morphology is closely associated with specific echocardiographic flow pattern in patients with atrial fibrillation

Petersen, Margot; Roehrich, Adalbert; Balzer, Jan C.; Shin, Dong‐In; Meyer, Christian; Kelm, Malte; Kehmeier, Eva

doi:10.1093/europace/euu347

Cited by 63 publications

(47 citation statements)

References 11 publications

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“…It has been demonstrated that non-banded LAA is associated with lower LAAV and a higher frequency of SEC compared with banded LAA [39]. We found no significant association between the incidence of LA abnormalities and different LAA morphologies.…”

Section: Discussioncontrasting

confidence: 77%

Incidence of left atrial abnormalities under treatment with dabigatran, rivaroxaban, and vitamin K antagonists

et al. 2016

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BackgroundNon-vitamin K antagonist oral anticoagulants (NOACs) such as dabigatran or rivaroxaban are alternatives to vitamin K antagonists (VKAs) for prevention of stroke and systemic embolism in patients with atrial fibrillation (AF) and atrial flutter (AFL). Incidences of risk factors for left atrium (LA) and left atrial appendage (LAA) thrombus formation, such as dense spontaneous echo contrast (SEC), low LAA velocity (LAAV) <20 cm/s under treatment with dabigatran and rivaroxaban in comparison with VKAs are unknown.MethodsWe studied 306 patients with AF (94 %) and AFL (6 %) undergoing transesophageal echocardiography. Patients received VKAs (n = 138), dabigatran (n = 68), or rivaroxaban (n = 100) for at least 3 weeks prior to investigation. Time in therapeutic range was 67 % for VKA. Mean CHADS2 score and CHA2DS2-VASc score were 1.3 and 2.5, respectively. Left atrial abnormality was defined as either dense SEC, low LAAV <20 cm/s, or thrombus.ResultsAny LA abnormality occurred in 9, 3, and 5 % of patients receiving VKA, dabigatran, and rivaroxaban, respectively. The most frequent abnormality was LAA thrombus (VKA: 4 %, dabigatran: 0 %, rivaroxaban: 2 %) and low LAAV of less than 20 cm/s (VKA: 4 %, dabigatran: 1 %, rivaroxaban: 1 %), followed by dense SEC (VKA: 2 %, dabigatran: 1 %, rivaroxaban: 2 %). Results of uni- and multivariate analyses revealed a numerically lower but not significantly different frequency of any LA abnormality under dabigatran (OR 0.4, 95 % Cl 0.08 − 1.88, p = 0.25) and rivaroxaban (OR 0.65, 95 % Cl 0.22 − 1.98, p = 0.45) compared to VKA.ConclusionWith respect to the incidence of LA abnormalities, dabigatran and rivaroxaban are not inferior to VKA.

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Section: Discussioncontrasting

confidence: 77%

Incidence of left atrial abnormalities under treatment with dabigatran, rivaroxaban, and vitamin K antagonists

et al. 2016

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“…Next, the echocardiography parameters [18] among the 3 groups, either pre- or postoperation, were found to be similar regarding interventricular septum thickness (IVS), left ventricular end-systolic diameter (LVDs), left ventricular end-diastolic diameter (LVDd), left ventricular posterior wall (LVPW), aortic diameter (AoD), ejection fraction (EF), pulmonary artery pressure (PAP), and left atrium diameter (LA). The diameter of LA was significantly increased in patients with AF and thrombus compared with patients with or without AF (Table 1).…”

Section: Resultsmentioning

confidence: 99%

Oncostatin M was associated with thrombosis in patients with atrial fibrillation

Xie

Zhu²,

Dai³

et al. 2017

Medicine

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The mechanism underlying thrombosis in atrial fibrillation (AF) is not yet clearly understood. Oncostatin M (OSM), as a member of IL-6 family, is involved in atherosclerosis-mediated thrombosis. The present study hypothesizes that OSM and its downstream factors play a role in thrombogenesis in AF.The specimens of left atrial appendages collected from patients with rheumatic mitral stenosis who underwent valve replacement were divided into 3 groups: sinus rhythm, AF(+)/thrombus(−), and AF(+)/thrombus(+) group. The macrophage infiltration in atrial tissue was assessed by immunohistochemistry, and the amount of OSM, tissue factor (TF), and tissue factor pathway inhibitors (TFPIs) was detected by Western blot.The infiltration of the M1 macrophages was significantly increased in the AF with thrombus group compared with the sinus rhythm group (P = .03). Moreover, the expression of OSM and TF was much higher in the AF with thrombus group compared with the sinus rhythm group (P = .02, .009, respectively) while the TFPI was decreased in the AF with thrombus group (P = .04).OSM might be correlated with thrombosis in patients with AF mediated by TF and TFPI.

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“…48 Furthermore, cauliflower LAA morphology was an independent predictor of stroke which is possibly related to extensive LAA trabeculations. 49 LAA flow velocity was highest among patients with chicken-wing as opposed to non-chicken wing morphology 29, 51, 52 which may explain why chicken wing morphology has the lowest risk of ischemic stroke. In addition, larger LAA orifice area has also been shown to be associated with ischemic stroke (Table).…”

Section: Left Atrial Appendage Function and Morphology In Relation Tomentioning

confidence: 97%

“…29 More recently, cardiac computed tomography (CCT) and cardiac magnetic resonance (CMR) have been used to further describe LAA morphology. A retrospective study of 932 patients with AF who underwent CCT or CMR categorized the LAA into four distinct morphologies: chicken wing (48%), cactus (30%), windsock (19%), and cauliflower (3%).…”

Section: Left Atrial Appendage Morphologymentioning

confidence: 99%

Left Atrial Appendage Function and Stroke Risk

Yaghi

Song

Gray

et al. 2015

Stroke

137

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Left atrial appendage morphology is closely associated with specific echocardiographic flow pattern in patients with atrial fibrillation

Cited by 63 publications

References 11 publications

Incidence of left atrial abnormalities under treatment with dabigatran, rivaroxaban, and vitamin K antagonists

Incidence of left atrial abnormalities under treatment with dabigatran, rivaroxaban, and vitamin K antagonists

Oncostatin M was associated with thrombosis in patients with atrial fibrillation

Left Atrial Appendage Function and Stroke Risk

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