Predicting reduced left atrial appendage velocity from echocardiographic left atrial function parameters in patients...

Area of Science:

• Cardiology
• Echocardiography
• Cardiac Electrophysiology

Background:

• Decreased left atrial appendage velocity (LAAV) is a key risk factor for thrombus formation in the left atrial appendage (LAA).
• Persistent atrial fibrillation (AF) poses challenges in predicting and managing thromboembolic events.
• Echocardiographic assessment of left atrial (LA) function is crucial for understanding hemodynamic changes.

Purpose of the Study:

• To evaluate the predictive role of echocardiographic left atrial (LA) function parameters for reduced LAAV.
• To identify specific LA function parameters that can predict low LAAV in patients with persistent AF undergoing catheter ablation.

Main Methods:

• Prospective enrollment of 150 patients with persistent AF undergoing transesophageal echocardiography (TEE) before catheter ablation.
• Measurement of LAAV and various LA function parameters including LA reservoir strain (LASr), conduit strain (LAScd), emptying fraction, e', LA stiffness index (LASI), LA volume index (LAVI), and E/e' ratio.
• Multivariable logistic regression analysis to identify significant predictors of reduced LAAV.

Main Results:

• 29.3% of patients had reduced LAAV (<25 cm/s).
• Reduced LAAV was associated with significantly lower LASr, LAScd, LA emptying fraction, and e' values.
• Higher LASI, LA area, right atrial area, LAVI, and E/e' ratio were observed in patients with reduced LAAV.
• LASI (threshold 1.6) and LAVI (threshold 44.47 ml/m²) were identified as significant independent predictors of reduced LAAV, with AUCs of 0.809 and 0.755, respectively.
• LASI was the sole significant predictor for LAAV <20 cm/s and <25 cm/s.

Conclusions:

• Echocardiographic parameters, particularly LASI and LAVI, are valuable noninvasive predictors of reduced LAAV in patients with persistent AF.
• LASI demonstrates strong predictive capability for reduced LAAV, offering potential for improved risk stratification.
• These findings support the use of comprehensive echocardiographic assessment to identify patients at higher risk of thrombus formation in the LAA.