Key result
Older age in nonvalvular AF is linked to ~24% lower LAA peak emptying velocity.
Why the study?
Age is an independent risk factor for thromboembolism in NVAF, and age-related differences in LAA function that may explain higher thromboembolic rates were not well defined.
Does older age (≥70 years) reduce left atrial appendage velocities compared to younger age (<70 years) in patients with nonvalvular atrial fibrillation?
Observational (n=42)
Does older age (≥70 years) reduce left atrial appendage velocities compared to younger age (<70 years) in patients with nonvalvular atrial fibrillation?
Older age is associated with reduced left atrial appendage velocities in patients with nonvalvular atrial fibrillation, potentially explaining their higher thromboembolic risk.
May partly explain higher thromboembolic risk in elderly nonvalvular AF; hypothesis-generating, requires prospective validation.
BACKGROUND: Age is an independent risk factor for thromboembolism in nonvalvular atrial fibrillation (NVAF). An association between low left atrial appendage (LAA) Doppler velocities and thromboembolic risk in NVAF has been reported. HYPOTHESIS: The study was undertaken to identify age-related differences in LAA function that may explain the higher thromboembolic rates in older patients with NVAF. METHODS: Forty-two consecutive patients (age 69+/-2 years [range 42-92], 24 [57%] men) with NVAF underwent transthoracic and transesophageal echocardiography. The following were compared in 22 patients younger and 20 older than 70 years: left ventricular (LV) diameter, mass and ejection fraction, left atrial (LA) diameter and volume, LAA area and volume, LAA peak emptying (PE) and peak filling (PF) velocities, presence and severity of spontaneous echo contrast (SEC) and mitral regurgitation (MR). RESULTS: Left atrial diameter (4.6+/-0.1 vs. 4.5+/-0.2 cm), LA volume (105+/-10 vs. 92+/-8 ml), LAA area (6.8+/-0.6 vs. 5.2+/-0.8 cm2), and LAA volume (5.6+/-0.9 vs. 3.9+/-1.0 ml) were similar (p>0.05) in both groups. Older patients had lower LAA PE (26+/-2 vs. 34+/-3 cm/s, p = 0.02) and PF (32+/-2 vs. 41+/-4 cm/s, p = 0.04) velocities, lower LV mass (175+/-13 vs. 234+/-21 gm, p = 0.02), higher relative wall thickness (0.52+/-0.02 vs. 0.43+/-0.03, p = 0.02), smaller LV diastolic diameter (4.3+/-0.1 vs. 5.2+/-0.2 cm, p < 0.001), and higher LV ejection fraction (62+/-2 vs. 55+/-2%, p = 0.025). Frequency and severity of SEC and MR were similar in both groups. Multivariate analysis identified older age as the only significant predictor of reduced LAA velocities. CONCLUSION: Compared with younger patients, older patients with NVAF have lower LAA velocities despite higher LV ejection fraction, smaller LV size, and similar LA and LAA volumes. These findings may explain the higher thromboembolic rates in older patients with NVAF.
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Ilercil et al. (2001) conducted an observational in Nonvalvular atrial fibrillation (n=42). Older age (≥70 years) vs. Younger age (<70 years) was evaluated on Left atrial appendage peak emptying velocity (p=0.02). Older age (≥70 years) in patients with nonvalvular atrial fibrillation was associated with significantly lower left atrial appendage peak emptying velocities compared to younger patients (26 vs 34 cm/s, p=0.02).
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