Left atrial appendage function assessment and thrombus identification

Jacek Kurzawski; Agnieszka Janion−Sadowska; Marcin Sadowski

doi:10.1016/j.ijcha.2016.11.003

December 10, 2016IJC Heart & VasculatureOpen Access

Left atrial appendage function assessment and thrombus identification

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Why the study?

Do tissue Doppler imaging and speckle tracking echocardiography parameters of the left atrial appendage differ between patients with atrial fibrillation and sinus rhythm?

Structured PICO

Do tissue Doppler imaging and speckle tracking echocardiography parameters of the left atrial appendage differ between patients with atrial fibrillation and sinus rhythm?

P

Population

80 patients with normal left ventricular ejection fraction, including 40 with sinus rhythm (SR) and 40 with non-valvular atrial fibrillation (AF) on oral anticoagulants (including patients with LAA thrombus).

I

Intervention

Tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE) of the left atrial appendage (LAA) basal segments (left lateral ridge and baso-medial appendage segment).

C

Comparator

Patients with sinus rhythm (SR).

O

Outcome

Quantitative differences in mechanical function of the LAA basal segments (peak velocity, average velocity, strain, strain rate, and deformation).surrogate

Strain rate in the left lateral ridge measured by Doppler and speckle tracking may serve as a novel parameter correlating with LAA thrombus in patients with atrial fibrillation.

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Implication

LAA TDI and speckle tracking metrics may aid thrombus detection in persistent AF; hypothesis-generating and requires prospective validation before practice change.

Abstract

BACKGROUND: The diagnosis of thrombus in the left atrium in patients with persistent atrial fibrillation (AF) and may be inconsistent because of variability in thrombus morphology. In some cases it is challenging and requires unusual approach. New Doppler-derived methods might be helpful to identify such thrombi. We evaluated quantitative differences in mechanical function of the left atrial appendage (LAA) basal segments using tissue Doppler imaging (TDI)and speckle tracking echocardiography (STE) in patients with non-valvular AF with and without LAA thrombus and compared them with SR patients. METHODS: A total of 80 patients with normal left ventricular ejection fraction underwent transesophageal echocardiography (40 patients with SR and 40 patients with AF on oral anticoagulants including patients with LAA thrombus). We analyzed the basal segments of LAA including left lateral ridge (LLR) and baso-medial appendage segment (BMAS). Quantitative analysis was used to calculate peak velocity, average velocity, strain, strain rate and deformation. Additionally, patients in SR demonstrated significantly better peak velocity, average velocity, strain, strain rate and deformation than those with AF (p < 0.001). CONCLUSIONS: LLR appeared to be an appropriate site for measuring Doppler derived parameters. It is possible that the strain rate in LLR area may be a novel parameter correlating with the presence of thrombus in patients with AF.

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Cite This Study

Kurzawski et al. (2016) studied this question.

synapsesocial.com/papers/6a7396808317ef39e84e68c9 https://doi.org/10.1016/j.ijcha.2016.11.003

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Left atrial appendage function assessment and thrombus identification

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Structured PICO

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Implication

Abstract

Discussion

Cite This Study

Left atrial appendage function assessment and thrombus identification

Figures

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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