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Evaluation of left atrial appendage functions in patients with thrombus and spontaneous echo contrast in left atrial
Ramazan Topsakal1, Namik Kemal Eryol, Yüksel Ciçek
1Department of Cardiology, Erciyes University, Medical Faculty, Kayseri, Turkey. topsakal@erciyes.edu.tr
Insights
In acute myocardial infarction patients, reduced left atrial appendage (LAA) emptying velocity and mid-systolic appendage tissue velocity (SaV) indicate LAA dysfunction, associated with thrombus or spontaneous echo contrast (SEC). Color Doppler tissue imaging effectively assesses LAA systolic function.
Area of Science:
- Cardiology
- Echocardiography
- Vascular Ultrasound
Background:
- Thrombus and spontaneous echo contrast (SEC) formation in the left atrial appendage (LAA) is linked to impaired LAA function.
- Reduced LAA emptying velocity is a key indicator of LAA dysfunction.
Purpose of the Study:
- To determine the incidence of SEC and/or thrombus in the LAA of patients experiencing acute myocardial infarction (AMI).
- To evaluate LAA function using color Doppler tissue imaging (CDTI) in AMI patients with detected SEC and/or thrombus.
Main Methods:
- Eighty-four AMI patients were divided into two groups: 24 with LAA thrombus/SEC (group 1) and 60 without (group 2).
- Transthoracic echocardiography assessed left atrial diameters and left ventricular ejection fraction.
- Transesophageal Doppler echocardiography measured LAA emptying and filling velocities.
- Transesophageal CDTI quantified systolic appendage tissue velocities (SaV) at the LAA medial wall (basal, mid, tip).
Main Results:
- Group 1 showed significantly lower LAA emptying velocities, mid-SaVs, and left ventricular ejection fractions compared to group 2.
- Group 1 also exhibited significantly increased left atrial diameters.
- LAA filling velocities and basal/tip SaVs were lower in group 1 but did not reach statistical significance.
Conclusions:
- Decreased mid-SaV of the LAA medial wall and reduced LAA emptying velocity signify LAA functional impairment in patients with thrombus/SEC.
- CDTI is a clinically viable and dependable method for quantitatively assessing regional LAA systolic function.
Objective:
Thrombus and spontaneous echo contrast (SEC) develops in the left atrial appendage (LAA) when LAA function is disturbed. Decrease of left atrial appendage emptying velocity shows LAA dysfunction. The purpose of this study is to examine the incidence of SEC and/or thrombus in LAA in patients with acute myocardial infarction and to assess the LAA function using color Doppler tissue imaging (CDTI) of the patients with detected SEC and/or thrombus.
Method And Results:
Eighty-four patients with acute myocardial infarction were included in the study. Spontaneous echo contrast and/or thrombus were observed in 24 (29%) of the 84 patients who were categorized as group 1 (mean age 59 +/- 12 years). Sixty patients (71%) without thrombus and/or SEC in LAA were categorized as group 2 (mean age 58 +/- 8 years). Left atrial diameters and left ventricular ejection fraction were measured by using transthoracic echocardiography. Left atrial appendage emptying and LAA filling velocity were measured by transesophageal Doppler echocardiography. Systolic appendage tissue velocities (SaV cm/s) were measured at the basal, mid, and tip of medial wall of LAA by transesophageal CDTI. Group 1 had significantly decreased LAA emptying velocities, mid SaVs, and left ventricular ejection fractions compared to group 2 (37 +/- 9 cm/s vs 55 +/- 22 cm/s, 3.1 +/- 1.6 cm/s vs 3.7 +/- 1.2 cm/s, and 47 +/- 13% vs 58 +/- 10%, respectively, P = 0.002, P = 0.04, P = 0.03). Group 1 had significantly increased left atrial diameters compared to group 2 (40 +/- 5 mm vs 36 +/- 6 mm P = 0.001). Left atrial appendage-filling velocities, basal SaVs and tip SaVs in group 1 were lower than those in group 2 but not significantly.
Conclusions:
Mid-SaV of LAA medial wall and LAA emptying velocity decrease in patients with thrombus and/or SEC were an indication of functional disorder of LAA. Color Doppler tissue imaging appears to be a clinically applicable and reliable imaging technique that allows quantitative assessment of regional LAA systolic function.
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