Incremental value of left atrial mechanical dispersion over CHA 2 DS 2‐ VAS c score in predicting risk of thrombus formation

Purpose To assess the potential ability of two‐dimensional speckle tracking analysis (STE) during atrial fibrillation (AF) to identify patients withLAappendage thrombi (LAAT). Methods This study involved 93 patients withAF(39% female, 67.1 ± 9.5 years) who were referred for a clinical indication for transesophageal echocardiography (TEE).TEErevealedLAATin 39 (42%) patients. We analyzed standard parameters of the left ventricle (LV) andLAin transthoracic echocardiography. UsingSTE, we assessedLVglobal longitudinal strain (LVGLS), peak atrial longitudinal strain (PALS), and intra‐atrial asynchrony. ThePALSwas calculated using the global strain curve (GPALS) and as the mean of peaks derived from segmental strain curves (MPALS). Results Patients were comparable with regard to the clinical data. A subgroup withLAAThad lowerLVejection fraction (LVEF) and a lower absolute value of theLVGLS, as well as greater impairment in theLAstandard parameters,PALS, and asynchrony. Receiver operating characteristic curve analysis revealed that theLVEFof 30% (P < .001), theLVGLSof −7% (P < .0001), theGPALSof 11% (P < .005), and theLAasynchrony of 22% (P < .01) were the optimal cutoff values for distinguishing both subgroups.LAasynchrony,LVEF, andLVGLSwere independently associated with the presence ofLAATin multivariate analyses, andPALShad additional significance over theCHA2DS2‐VASc score. Conclusions Left ventricular systolic dysfunction characterized by bothLVEFandLVGLSis an independent factor forLAAT.LAasynchrony provides additional diagnostic value for discriminating between patients with and withoutLAAT.