Key result
Severe rheumatic mitral stenosis in sinus rhythm was associated with a 73% prevalence of left atrial appendage inactivity, independently predicted by mitral valve mean gradient, Sa-wave and fibrinogen.
Why the study?
Systemic thromboembolism complicates rheumatic mitral stenosis in sinus rhythm, and the left atrial appendage is usually hypocontractile in these patients, but the prevalence and independent predictors of left atrial appendage inactivity remained unclear.
Observational (n=100)
In patients with severe rheumatic mitral stenosis in sinus rhythm, left atrial appendage inactivity is highly prevalent (73%) and is independently predicted by mitral valve mean gradient, lateral annulus systolic velocity, and serum fibrinogen.
Answers are grounded in this paper and cite their sources.
High LAA inactivity in severe rheumatic MS in SR warrants TEE vigilance; leaves open anticoagulation trials in sinus rhythm.
BACKGROUND: Systemic thromboembolism is a known complication of rheumatic mitral stenosis (RMS) in sinus rhythm (SR). Left atrial appendage (LAA), the commonest site of thrombus formation is usually hypocontractile (inactive) in such patients. We aimed to study the prevalence of LAA inactivity (LAAI) in severe RMS and assess its independent predictors. METHODS: The study population consisted of 100 patients of severe RMS in SR. Transthoracic and transesophageal echocardiography were done to assess LAA contractile function. Patients with LAA-peak emptying velocity < 25 cm/seconds were defined as having LAAI. RESULTS: The mean age of study subjects was 31.66±8.69 years and 56% were females. 73% patients had LAAI (Group A), while remaining 27% had normal LAA function (Group B). Mitral-valve area (MVA) and lateral annulus systolic velocity (Sa-wave) were significantly lower while mitral valve mean gradient (MVMG) and serum fibrinogen were significantly higher (all p-values < 0.001) in group A patients. On multivariate binary logistic regression analysis, MVMG (p < 0.001), Sa-wave (p = 0.02), and serum fibrinogen (p = 0.005) were independent predictors of LAAI. Optimal cut-off values of MVMG, Sa-wave and serum fibrinogen for predicting LAAI were 11.5 mm Hg, 6.8 cm/seconds and 300 mg/dl, respectively. Sixty-Seven (90.55%) patients in group A compared to 13(48.1%) in group B had LA/LAA smoke. LAAI was the only independent predictor of left atrium (LA)/LAA smoke with or without associated thrombus. CONCLUSION: There is high prevalence of LAAI in patients of severe MS in SR. MVMG, Sa-wave, and serum fibrinogen levels are independent predictors of LAAI. LAAI is an independent predictor of LA/LAA smoke with or without associated thrombus.
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Mukhopadhyay et al. (2021) conducted an observational in Severe rheumatic mitral stenosis in sinus rhythm (n=100). Severe rheumatic mitral stenosis in sinus rhythm was evaluated on Left atrial appendage inactivity (LAAI). Severe rheumatic mitral stenosis in sinus rhythm was associated with a 73% prevalence of left atrial appendage inactivity, independently predicted by mitral valve mean gradient, Sa-wave and fibrinogen.
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