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Prognostic value of left atrial appendage function in patients with dilated cardiomyopathy
1Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan. in3016@poh.osaka-med.ac.jp
Insights
Left atrial appendage (LAA) emptying velocity, assessed by transesophageal echocardiography (TEE), can predict clinical outcomes in dilated cardiomyopathy (DCM) patients. Lower LAA emptying velocity indicates a higher risk of cardiac death in DCM.
Area of Science:
- Cardiology
- Echocardiography
Background:
- Dilated cardiomyopathy (DCM) is a significant cause of heart failure.
- Predicting clinical outcomes in DCM patients is crucial for effective management.
- The role of left atrial appendage (LAA) function in DCM prognosis requires further investigation.
Purpose of the Study:
- To evaluate if left atrial appendage (LAA) function parameters, measured by transesophageal echocardiography (TEE), can predict clinical outcomes in patients with dilated cardiomyopathy (DCM).
Main Methods:
- Fifty-five DCM patients underwent TEE to assess LAA function.
- Patients were followed for a mean of 34 months to record mortality.
- Cox proportional hazards models and stepwise multivariate analysis were used to identify predictors of cardiac death.
Main Results:
- Patients who died of cardiac causes had significantly lower LAA emptying velocity compared to survivors (38 vs. 54 cm/s, p=0.01).
- LAA emptying velocity <50 cm/s and LAA ejection fraction <43% were significant predictors of cardiac death.
- Multivariate analysis identified LAA emptying velocity and female gender as independent predictors of outcome.
Conclusions:
- Parameters of LAA function, particularly emptying velocity, are valuable predictors of clinical outcomes in DCM patients.
- TEE assessment of LAA function can aid in risk stratification and management of DCM.
- Further research may explore the mechanisms linking LAA dysfunction to adverse outcomes in DCM.
Abstract:
The purpose of the present study was to determine whether parameters of left atrial appendage (LAA) function, assessed by transesophageal echocardiography (TEE), could predict the clinical outcome in patients with dilated cardiomyopathy (DCM). Fifty-five patients (20 had ischemic cardiomyopathy; mean age, 56+/-14 years) who underwent TEE to evaluate LAA function from 1992 to 1996 were studied. After a mean follow-up period of 34+/-13 months, 16 patients died; the cause was cardiac in 14 and noncardiac in 2. Patients who died of cardiac cause had a lower LAA emptying velocity than survivors (38+/-18 vs 54+/-18 cm/s, p=0.01). There were, however, no significant differences between survivors and nonsurvivors with regard to the maximal LAA area (4.3+/-1.3 vs 4.5+/-0.9 cm2, p=0.55), minimal LAA area (2.4+/-1.1 vs 2.9+1.1 cm2, p=0.13), and LAA ejection fraction (46+/-16 vs 36+/-18%, p=0.05). On the Cox proportional hazards model analysis, LAA emptying velocity <50 cm/s (chi-square 5.9, p=0.02), LAA ejection fraction <43% (chi-square 5.6, p=0.02), female gender (chi-square 5.2, p=0.02), pulmonary artery wedge pressure > or =14 mmHg (chi-square 4.8, p=0.03), E/A ratio > or =1.3 (chi-square 4.6, p=0.03), deceleration time <148 ms (chi-square 4.6, p=0.03), and cardiothoracic ratio > or =54% (chi-square 4.3, p=0.04) were significantly related to cardiac death. The stepwise multivariate analysis revealed that LAA emptying velocity (chi-square 6.1, p=0.01) and gender (chi-square 5.4, p=0.02) were the independent predictors for outcome. In conclusion, the parameters of LAA function may be useful predictors of the clinical outcome in patients with DCM.