Key result
Moderate-to-severe MR linked to ~65% lower odds of reduced LAA emptying velocity.
Why the study?
Prior literature on whether mitral regurgitation increases left atrial turbulence and left atrial appendage emptying velocity was conflicting.
Is moderate-to-severe or severe mitral regurgitation associated with increased left atrial appendage emptying velocity in patients undergoing transesophageal echocardiography?
Observational (n=995)
No
Is moderate-to-severe or severe mitral regurgitation associated with increased left atrial appendage emptying velocity in patients undergoing transesophageal echocardiography?
Moderate-to-severe or severe mitral regurgitation is independently associated with higher left atrial appendage emptying velocity, suggesting a potential protective role against AF-related cardioembolic stroke.
Answers are grounded in this paper and cite their sources.
Greater than moderate mitral regurgitation was associated with higher LAAev; hypothesis-generating for appendage thrombosis risk in AF.
Introduction: Atrial fibrillation (AF) increases the risk of stroke due to thromboembolism from the left atrial appendage (LAA). LAA emptying velocity (LAAev) is measured with transesophageal echocardiograms (TEEs) and is a surrogate for LAA thrombosis and stroke risk. Although the literature is conflicting, we hypothesized that mitral regurgitation (MR) would increase turbulence in left atrium and increase LAAev. Methods: TEE imaging and reports from 2016 to 2022 at The University of Kansas Medical Center were reviewed to obtain LAAev. MR was assessed using echocardiography reports. Univariate and multivariate linear and logistic regressions were used to analyze the association between moderate-to-severe or severe MR (>moderate MR) and LAAev. The multivariate models were adjusted for age, sex, and significant univariate predictors. Results: The study included 995 TEEs (38.1% female, mean age 71.3 ± 12.7 years) with 817 (82.1%) having a history of AF. The mean LAAev was 41.6 ± 21.0 cm/s with > moderate MR present in 50 (5.0%) patients, associated with 7.8 ± 3.0 cm/s increase in LAAev ( P = 0.01) in univariate, and 6.1 ± 3.0 cm/s increase ( P = 0.04) in multivariate linear regression. The adjusted odds ratio for reduced LAAev (<30 cm/s) for > moderate MR was 0.43 (95% confidence interval 0.21, 0.89, P = 0.02) in univariate and 0.35 (0.15, 0.79, P = 0.01) in multivariate logistic regression. Conclusions: Our results support an independent association between MR and increased LAAev, suggesting a possible protective role of MR in AF-related cardioembolic stroke. This merits further validation before incorporation in cardioembolic risk-stratification systems.
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Tabak et al. (2026) conducted an observational in Atrial fibrillation and mitral regurgitation (n=995). Moderate-to-severe or severe mitral regurgitation (>moderate MR) vs. Mild or less mitral regurgitation (≤moderate MR) was evaluated on Reduced left atrial appendage emptying velocity (<30 cm/s) (OR 0.35, 95% CI 0.15-0.79, p=0.01). Moderate-to-severe or severe mitral regurgitation was independently associated with increased LAA emptying velocity (+6.1 cm/s, P=0.04) and lower odds of velocity <30 cm/s (OR 0.35; 95% CI 0.15-0.79).
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