Turk Kardiyol Dern Ars. Ahead of Print: TKDA-39482 | DOI: 10.5543/tkda.2019.39482
Left atriyal appendage strain assessed directly by transosophageal echocardiography predicts thromboembolic risk in patients with atrial fibrillation
, DİLEK URAL2
, Salih Kilic1
, Ertan Vuruskan1
, TAYFUN ŞAHİN2
, Ayşen Ağaçdiken Ağır1
Gaziantep Dr. Ersin Arslan Training and Research Hospital, Department of Cardiology2
Kocaeli University, School of Medicine, Department of Cardiology
This study aimed to determine the relation of left atrial appendage (LAA) mechanics assessed by 2D-strain analysis of the gray scale images obtained during transesophageal echocardiography (TEE) to the conventional LAA functional parameters, to CHA2DS2-VASc score and to the presence of spontaneous echo contrast (SEC) and/or LAA thrombus in patients with non-valvular atrial fibrillation (AF). Keywords:
RESULTS The study included 126 patients with AF and 30 controls with sinus rhythm who were referred for TEE. Global, medial, lateral and apical LAA longitudinal 2D-strain of AF patients were significantly lower than the controls and showed moderate but significant correlations to LAA flow velocities and to LAA area change. Patients with CHA2DS2-VASc score of 0-1 had highest LAA 2D-strain values and independent correlates of CHA2DS2-VASc score were LAA-emptying velocity, followed by LAA lateral and medial 2D-strain. SEC was detected in 84 patients, among which 42 had dense SEC and 27 had thrombus in LAA. Multivariate analysis revealed that LAA emptying velocity, LAA area change and LAA medial 2D-strain were independent associates of the presence of dense SEC/thrombus. A ROC analysis revealed that cut-off values of global, medial, apical and lateral 2D-strain for the presence of dense SEC/thrombus were 6.0% (P =0.011), 8.0% (P =0.032), 6.0% (P =0.033) and 5,4% (P =0.004), respectively.
CONCLUSIONS Global and regional LAA mechanics are significantly related to the conventional LAA functional parameters and to the presence of LAA dense SEC/thrombus in patients with AF and maybe useful as a complementary technique for estimating future thromboembolism.
Left atrial appendage, speckle tracking echocardiography, thoromboemboli, CHA2DS2-VASc score
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Corresponding Author: Erhan Saraçoğlu, Türkiye