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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
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Relationship between left ventricular diastolic function and the risk of left atrial appendage thrombus in patients

Gaigai Ma1, Ligang Fang2, Xue Lin2

  • 1Department of Cardiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, China.

The International Journal of Cardiovascular Imaging
|January 4, 2023
PubMed

Insights

Left ventricular diastolic dysfunction, indicated by elevated left atrial pressure, is linked to a higher risk of left atrial appendage thrombus in nonvalvular atrial fibrillation patients. Transesophageal echocardiography can assess this risk.

Area of Science:

  • Cardiology
  • Echocardiography
  • Atrial Fibrillation Research

Background:

  • Left atrial appendage (LAA) thrombus is a significant risk in nonvalvular atrial fibrillation (NVAF).
  • The role of left ventricular diastolic function in LAA thrombus formation remains understudied in NVAF patients.

Purpose of the Study:

  • To investigate the relationship between left ventricular diastolic function and the risk of LAA thrombus in patients with NVAF.
  • To explore the utility of echocardiographic parameters in assessing this risk.

Main Methods:

  • Prospective enrollment of 76 NVAF patients undergoing radiofrequency catheter ablation.
  • Transthoracic echocardiography (TTE) for diastolic function (LAVI, E/e') and invasive left atrial pressure (LAP) measurement.
  • Transesophageal echocardiography (TEE) for LAA peak emptying velocity (LAA-PEV) and spontaneous echo contrast (SEC) intensity.

Main Results:

  • Average E/e', LAVI, and mean LAP positively correlated with SEC intensity (p<0.001).
  • Elevated LAP independently correlated with LAA thrombus risk (SEC ≥ Grade 2) after adjusting for CHA₂DS₂-VASc score and AF type (OR 1.144, p=0.031).
  • LAA-PEV demonstrated an inverse relationship with mean LAP (r=-0.525, p<0.001); a LAA-PEV cut-off of 0.40 m/s predicted elevated LAP with 80% sensitivity and 81% specificity.

Conclusions:

  • Left ventricular diastolic dysfunction, particularly elevated left atrial pressure, is a potential risk factor for LAA thrombus and subsequent stroke in NVAF.
  • TEE assessment of LAA emptying velocity is valuable for evaluating left atrial pressure status in AF patients.

Keywords:
Atrial fibrillationDiastolic functionLeft atrial appendage thrombusLeft atrial pressureSpontaneous echo contrast

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