Left atrial appendage function in patients with mitral stenosis in sinus rhythm

Area of Science:

• Cardiology
• Echocardiography
• Thrombosis

Background:

• Rheumatic mitral stenosis in atrial fibrillation is linked to left atrial appendage thrombi, a source of embolism.
• Limited research exists on left atrial appendage dysfunction in mitral stenosis patients with sinus rhythm.

Purpose of the Study:

• To investigate left atrial appendage function and flow patterns in patients with rheumatic mitral stenosis in sinus rhythm.
• To assess the prevalence of spontaneous echocardiographic contrast and thrombus formation in this patient group.

Main Methods:

• Transesophageal echocardiography was used to study 41 patients with rheumatic mitral stenosis in sinus rhythm and 11 healthy controls.
• Left atrial appendage ejection fraction, flow velocities, spontaneous echocardiographic contrast, and thrombus formation were assessed.

Main Results:

• Patients with mitral stenosis exhibited significantly decreased left atrial appendage emptying and filling velocities compared to controls.
• Mitral stenosis patients had a larger left atrial appendage area and reduced ejection fraction.
• Spontaneous echocardiographic contrast was observed in seven patients, with one developing left atrial appendage thrombus; this group showed decreased ejection fraction.

Conclusions:

• Left atrial appendage dysfunction, including impaired function and altered flow, can occur in patients with mitral stenosis even when in sinus rhythm.
• The findings suggest a potential link between mitral stenosis, left atrial appendage dysfunction, and thrombus formation, even in sinus rhythm.