title: Ratio of peak early to late diastolic filling velocity of the left ventricular inflow is associated with left atrial appendage thrombus formation in elderly patients with acute ischemic stroke and sinus rhythm.
abstract: OBJECTIVE
  To investigate the useful parameters of transthoracic echocardiography (TTE) for the diagnosis of stroke subtypes in patients with acute cerebral infarction.
  
  
  METHODS
  One hundred and one acute ischemic stroke patients met all of the following criteria; > or = 50 years of age, normal sinus rhythm on admission, and transesophageal echocardiography (TEE) within 7 days from the onset. The clinical significance of the TTE parameters on admission was examined for identifying intracardiac thrombus formation as follows: left atrial dimension, left ventricular end-diastolic dimension, percentage fractional shortening, left ventricular mass index, ratio of the transmitral inflow velocities (E/A), and deceleration time of the E wave.
  
  
  RESULTS
  There were 28 patients with E/A > or = 1.0(70 +/- 12 years old) and 73 with E/A < 1.0 (73 +/- 10 years old). No patient showed pulmonary congestion on chest radiography. There were no significant differences in age, TTE parameters, and plasma levels of brain natriuretic peptide between the two groups. Patients with E/A > or = 1.0 had higher incidence of left atrial appendage thrombus formation and/or spontaneous echographic contrast than those with < 1.0 (25% vs 5%, p = 0.0058). There was a significant relationship between E/A and emptying flow velocity of the left atrial appendage (r = -0.569, p < 0.0001). Multivariate logistic regression analysis showed E/A was an independent predictor for left atrial appendage thrombus (risk ratio 1.531 per 0.1 increase, 95% confidence interval 1.129-2.076, p = 0.0002).
  
  
  CONCLUSIONS
  Increased level of E/A on admission was associated with the occurrence of left atrial appendage thrombus formation in patients with acute ischemic stroke.
authors.affiliation: Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine.
authors.forename: Liu
authors.initials: L
authors.lastname: Ling
authors.forename: Osamu
authors.initials: O
authors.lastname: Hirono
authors.forename: Hidenobu
authors.initials: H
authors.lastname: Okuyama
authors.forename: Yasuchika
authors.initials: Y
authors.lastname: Takeishi
authors.forename: Takamasa
authors.initials: T
authors.lastname: Kayama
authors.forename: Isao
authors.initials: I
authors.lastname: Kubota
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020517:Atrial Appendage; D001783:Blood Flow Velocity; D017548:Echocardiography, Transesophageal; D004569:Electroencephalography; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000150:complications* / Q000503:physiopathology; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology*; D016277:Ventricular Function, Left / Q000502:physiology