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Left atrial appendage smoke-like echo in dilated cardiomyopathy: its clinical significance and relation to left
Insights
Smoke-like echo in the left atrial appendage (LAA) indicates increased thromboembolic risk in dilated cardiomyopathy (DCM) patients. This finding is linked to a dilated, poorly functioning LAA, highlighting its clinical significance.
Area of Science:
- Cardiology
- Echocardiography
- Thrombosis
Background:
- Dilated cardiomyopathy (DCM) is associated with an increased risk of thromboembolic events.
- Left atrial appendage (LAA) dysfunction is a known contributor to thrombus formation in various cardiac conditions.
- The clinical significance of smoke-like echo (SE) within the LAA in DCM patients requires further elucidation.
Purpose of the Study:
- To investigate the clinical significance and pathogenesis of LAA smoke-like echo (SE) in patients with dilated cardiomyopathy (DCM).
- To assess the association between LAA SE and thromboembolic events in DCM.
- To evaluate LAA anatomy and function in DCM patients with and without SE.
Main Methods:
- Transesophageal echocardiography was used to assess LAA anatomy and function.
- A cohort of 18 DCM patients with SE, 34 DCM patients without SE, and 14 age-matched normal controls were studied.
- Clinical history, including atrial fibrillation and arterial embolic episodes, was recorded.
Main Results:
- DCM patients with SE exhibited a larger LAA area, reduced peak LAA systolic flow velocity (PLAAV), and a higher incidence of atrial fibrillation, LAA thrombi, and arterial embolic episodes compared to those without SE.
- In sinus rhythm, DCM patients with SE had significantly larger minimal LAA area, lower LAA ejection fraction, and lower PLAAV than those without SE.
- DCM patients with atrial fibrillation and SE had significantly lower PLAAV than AF patients without SE.
Conclusions:
- Smoke-like echo in the LAA is a significant indicator of increased thromboembolic risk in DCM patients.
- The presence of SE is associated with a dilated and poorly contractile LAA.
- LAA SE provides valuable insights into the pathogenesis of embolic events in DCM.
Abstract:
To elucidate the clinical significance and pathogenesis of left atrial appendage smoke-like echo in dilated cardiomyopathy (DCM), clinical history and transesophageal echocardiographic assessment of left atrial appendage (LAA) anatomy and function were studied in 18 DCM patients with smoke-like echo (SE), 34 patients with DCM but no smoke-like echo and in 14 age-matched normal subjects. Patients with SE had a larger left atrial appendage area, a lower peak LAA systolic flow velocity (PLAAV), a greater incidence of atrial fibrillation, with both left atrial appendage thrombi and a history of arterial embolic episodes, than did patients without SE. Patients in sinus rhythm with SE had a minimal LAA area (5.0 +/- 3.0 cm2) larger than that in the no SE group (3.0 +/- 1.6 cm2) (p < 0.05), and LAA ejection fraction (18 +/- 10%) and PLAAV (24 +/- 9 cm/sec) less than that in the no SE group (40 +/- 11% and 39 +/- 16 cm/sec, respectively) (P < 0.05). Patients with atrial fibrillation (AF) and SE had PLAAV (15 +/- 6 cm/sec) less than that in AF patients without SE (30 +/- 12 cm/sec) (p < 0.05). It is concluded that smoke-like echo in LAA is an indicator of DCM patients with an increased thromboembolic risk usually associated with dilated and poorly contractile LAA.