Prognostic value of low left atrial appendage wall velocity in patients with ischemic stroke and atrial fibrillation.
BACKGROUND
It is important to evaluate left atrial appendage (LAA) dysfunction for primary and secondary prevention of stroke in patients with atrial fibrillation (AF). LAA dysfunction can reportedly be evaluated by LAA wall velocity (LAWV) measured by transthoracic echocardiographic (TTE) imaging. The aim of this study was to examine whether TTE-LAWV can predict long-term cerebrovascular events in patients with ischemic stroke with AF.


METHODS
TTE imaging and transesophageal echocardiographic imaging were performed <7 days after onset in 179 consecutive patients with stroke with AF. TTE-LAWV was measured using Doppler tissue imaging at the LAA tip from the parasternal short-axis view on TTE imaging, as previously reported. All patients were followed up prospectively.


RESULTS
Cerebrovascular events were defined as cerebrovascular death and/or recurrent ischemic stroke requiring hospitalization. There were 32 cerebrovascular events during a median follow-up period of 397 days. TTE-LAWV was significantly lower in patients with cerebrovascular events than in patients without (8.3 ± 2.8 vs 11.3 ± 4.0 cm/sec, P < .01). Cox multivariate hazard analysis showed that low TTE-LAWV (<8.7 cm/sec) was an independent predictor of cerebrovascular events (hazard ratio, 3.460; P < .05). Kaplan-Meier analysis showed that cerebrovascular event rates were significantly higher in patients with low TTE-LAWV (<8.7 cm/sec) compared with those with high TTE-LAWV (34% vs 7%, P < .01).


CONCLUSIONS
Impaired LAA function was associated with long-term cerebrovascular events in patients with stroke with AF. TTE-LAWV may be a feasible parameter for risk stratification in patients with AF.
Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan.
Harutoshi
H
Tamura
Tetsu
T
Watanabe
Satoshi
S
Nishiyama
Shintaro
S
Sasaki
Masahiro
M
Wanezaki
Takanori
T
Arimoto
Hiroki
H
Takahashi
Tetsuro
T
Shishido
Takehiko
T
Miyashita
Takuya
T
Miyamoto
Isao
I
Kubota
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000925:Anticoagulants / Q000627:therapeutic use; D020517:Atrial Appendage / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000401:mortality; D016279:Atrial Function, Left; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality; D015331:Cohort Studies; D018450:Disease Progression; D018619:Echocardiography, Doppler, Pulsed / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D018570:Risk Assessment; D020521:Stroke / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000401:mortality; D016019:Survival Analysis
D000925:Anticoagulants