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Updated: Dec 27, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left atrial appendage mechanical dispersion provides incremental value for thromboembolic risk stratification over
Yankai Mao1, Mingming Ma1, Yuan Yang1
1Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Insights
Left atrial appendage mechanical dispersion (MD) assessed by echocardiography is linked to thromboembolic events in atrial fibrillation (AF) patients. This measurement improves risk prediction beyond the CHA2DS2-VASc score.
Area of Science:
- Cardiology
- Medical Imaging
- Thrombosis Research
Background:
- Left atrial appendage (LAA) dysfunction increases thromboembolic risk.
- Limited understanding of LAA mechanical dispersion (MD) in predicting thromboembolism.
- Need for improved risk stratification in nonvalvular atrial fibrillation (AF).
Purpose of the Study:
- To assess the association between LAA mechanics and thromboembolic events.
- To evaluate LAA mechanical dispersion (MD) using speckle-tracking imaging.
- To determine if LAA MD improves risk prediction over the CHA2DS2-VASc score.
Main Methods:
- 116 AF patients underwent transesophageal echocardiography (TEE).
- LAA strain measured in 24 segments using speckle-tracking echocardiography (STE).
- LAA MD defined as SD of time to peak positive strain (R-R corrected).
Main Results:
- Embolic patients had lower LAA global longitudinal strain and higher LAA MD.
- LAA MD >13.1% differentiated patients with embolism (AUC 0.709).
- LAA MD independently associated with thromboembolism and improved CHA2DS2-VASc model.
Conclusions:
- LAA MD from strain echocardiography correlates with embolic events.
- LAA MD offers incremental value over CHA2DS2-VASc score for risk stratification.
- LAA MD may refine thromboembolic risk assessment in AF patients.
Background:
Left atrial appendage (LAA) dysfunction is associated with increased risk of thromboembolic events. However, little is known about LAA mechanical dispersion (MD) would provide additional information toward thromboembolism over the CHA2DS2-VASc score. The aim of this study was to determine the association of LAA mechanics as assessed by speckle-tracking imaging with thromboembolic events in patients with nonvalvular atrial fbrillation (AF).
Methods:
A total of 116 consecutive patients with AF referred for transesophageal echocardiography (TEE) were prospectively enrolled. Of these, 17(14.7%) patients had prior embolic events. Using speckle-tracking echocardiography (STE), we measured the LAA strain in each of 24 segments in mid-esophageal TEE views obtained at 0°, 45°, 90° and 135°. LAA MD was defined as the standard deviation (SD) of time to peak positive strain corrected by the R-R interval.
Results:
Patients with embolism had lower LAA global longitudinal strain (GLS) (8.56 ± 2.62% vs 11.37 ± 5.54%, p = 0.002) and higher LAA MD (16.90 ± 6.67% vs 12.10 ± 3.94%; P = 0.010) than those without embolism. LAA MD >13.1% differentiated patients with embolism from controls, with an area under the curve (AUC) of 0.709(p = 0.004). LAA MD was independently associated with the presence of thromboembolism in multivariate analysis (odds ratio, 1.24; 95% confidence interval, 1.08-1.42; P = 0.002). The model based on CHA2DS2-VASc score for discrimination of patients with embolism was significantly improved by adding LAA MD (P < 0.01).
Conclusion:
LAA MD obtained from strain echocardiography was significantly associated with a prior history of embolic events and had incremental diagnostic value over CHA2DS2VASc score, suggesting that LAA MD may be useful in refining thromboembolic risk stratification in patients with AF.
