Effect of elevated left ventricular diastolic filling pressure on the frequency of left atrial appendage thrombus in patients with nonvalvular atrial fibrillation.
We investigated the relation between left ventricular diastolic dysfunction and left atrial appendage (LAA) thrombus in patients with atrial fibrillation (AF). We performed transesophageal echocardiography to examine LAA thrombus or spontaneous echo contrast (SEC) and to measure LAA emptying flow velocity in consecutive 376 patients with AF. We estimated diastolic filling pressure as the ratio of early transmitral flow velocity (E) to mitral annular velocity (e') on transthoracic echocardiogram. E/e' ratio in 28 patients (7.4%) with LAA thrombi was higher than that in patients without thrombus (18.3 ± 9.3 vs 11.4 ± 5.9, p <0.0001). The fourth quartile of E/e' (>13.6) consisted of 19 patients with thrombi and had a higher prevalence of thrombi than the others (p <0.0001). Multivariate regression analysis selected E/e' ≥13 as an independent predictor of LAA thrombus with an odds ratio of 3.50 (1.22 to 10.61) in addition to LA dimension and ejection fraction. Increased quartile of E/e' was negatively associated with LAA flow velocity and positively with rate of SEC. In conclusion, increased diastolic filling pressure is associated with a higher rate of LAA thrombus in AF, partly through blood stasis or impaired LAA function.
Sakurabashi Watanabe Hospital, Osaka, Japan. iwakura@mac.com
Katsuomi
K
Iwakura
Atsushi
A
Okamura
Yasushi
Y
Koyama
Motoo
M
Date
Yoshiharu
Y
Higuchi
Koichi
K
Inoue
Ryusuke
R
Kimura
Hiroyuki
H
Nagai
Yuko
Y
Toyoshima
Makito
M
Ozawa
Norihisa
N
Ito
Masahiko
M
Shibuya
Shigemiki
S
Omiya
Takashi
T
Takagi
Daisuke
D
Morisawa
Kenshi
K
Fujii
D001281:Atrial Fibrillation / Q000150:complications*; D001783:Blood Flow Velocity; D003971:Diastole / Q000502:physiology*; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006331:Heart Diseases / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D013927:Thrombosis / Q000209:etiology*; D016277:Ventricular Function, Left / Q000502:physiology*