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Left atrial appendage flow velocity assessment using transesophageal echocardiography in nonrheumatic atrial
P M Verhorst1, O Kamp, C A Visser
1Free University Hospital, Amsterdam, The Netherlands.
Insights
In patients with nonrheumatic atrial fibrillation (AF), lower left atrial (LA) appendage flow velocities detected by transesophageal echocardiography (TEE) indicate a higher risk of systemic embolism. This finding may help identify high-risk individuals.
Area of Science:
- Cardiology
- Echocardiography
- Vascular Medicine
Background:
- Nonrheumatic atrial fibrillation (AF) is a common condition associated with an increased risk of systemic embolism.
- Identifying patients with AF who are at high risk for embolism is crucial for effective prevention strategies.
Purpose of the Study:
- To investigate the association between left atrial (LA) appendage flow dynamics and the occurrence of systemic embolism in patients with nonrheumatic AF.
- To evaluate whether transesophageal echocardiography (TEE) parameters can predict embolic events in this patient population.
Main Methods:
- Fifty-four patients with nonrheumatic AF were divided into two groups: those with (n=16) and without (n=38) documented systemic embolism.
- Transesophageal echocardiography (TEE) was used to assess left atrial (LA) appendage thrombus, spontaneous contrast, LA size, pulmonary vein flow, and LA appendage flow velocities.
Main Results:
- No significant difference in LA thrombus presence was found between the groups.
- Left atrial spontaneous contrast was significantly higher in patients with embolism (p=0.01).
- Significantly lower forward (p<0.05) and backward (p<0.05) peak velocities of the LA appendage were observed in the embolism group, suggesting impaired flow.
Conclusions:
- Left atrial appendage flow velocity, assessed by TEE, may serve as a valuable indicator for identifying patients with nonrheumatic AF at high risk for systemic embolism.
- These findings suggest that impaired LA appendage flow dynamics are associated with embolic events in AF patients.
Abstract:
Fifty-four patients with nonrheumatic atrial fibrillation (AF) were studied: 16 patients with (group I) and 38 patients without (group II) documented systemic embolism. Transesophageal echocardiography (TEE) was performed to evaluate the presence of left atrial (LA) appendage thrombus and LA spontaneous contrast, LA size, systolic and diastolic peak velocity of the left pulmonary vein, and forward and backward peak velocity of the LA appendage. No difference was observed in the presence of LA thrombus between the 2 groups. The occurrence of LA spontaneous contrast was significantly (p = 0.01) higher in the group with embolism. LA size, measured by atrial length (4.96 +/- 0.84 vs 4.79 +/- 1.38 cm; p = NS) and atrial width (4.50 +/- 0.96 vs 4.31 +/- 1.24 cm; p = NS), was the same for both groups and thus not associated with embolism. There was no difference in systolic peak velocity (0.39 +/- 0.22 vs 0.44 +/- 0.22 m/s; p = NS), and a trend toward a higher diastolic peak velocity (0.50 +/- 0.17 vs 0.42 +/- 0.15 m/s; p = 0.08) was seen in the left pulmonary vein in the group with embolism. Forward (0.25 +/- 0.19 vs 0.39 +/- 0.23 m/s; p < 0.05) and backward (0.23 +/- 0.15 vs 0.33 +/- 0.16 m/s; p < 0.05) peak velocities of the LA appendage were significantly lower in the embolism group. Assessment of LA appendage flow velocity may potentially identify patients with nonrheumatic AF at high risk for systemic embolism.