title: Estimation of left atrial blood stasis using diastolic late mitral annular velocity.
abstract: OBJECTIVE
  Diastolic late mitral annular velocity (a') measured by transthoracic echocardiography (TTE) is reported to represent left atrial (LA) pump function and the severity of LA remodelling. The purpose of this study is to investigate the association between a' and LA blood stasis in patients with non-valvular paroxysmal atrial fibrillation.
  
  
  RESULTS
  We enrolled 138 consecutive patients with non-valvular paroxysmal atrial fibrillation who had spontaneous sinus rhythm at the time of echocardiography. Using TTE, a' was determined as an average of tissue Doppler velocities measured at septal and lateral mitral annuli. Transoesophageal echocardiography was also performed on the same day as TTE, and spontaneous echo contrast (SEC) and LA appendage flow velocity were examined. Spontaneous echo contrast was observed in 21 (15%) patients. Patients in the lowest quartile of a' (≤6.4 cm/s) demonstrated SEC more frequently (44 vs. 6%, P < 0.0001) and had lower LA appendage flow velocity (39 ± 13 vs. 53 ± 16 cm/s, P < 0.0001) than those in the other quartiles. Receiver-operating characteristic curve analysis showed that the best cut-off value of a' was 7.0 cm/s for the prediction of SEC with a sensitivity of 80%, specificity of 81%, and predictive accuracy of 80%. Multivariate analysis revealed that decreased a' (OR = 0.61, P = 0.0026) was independently associated with SEC.
  
  
  CONCLUSIONS
  Decreased a' may be a useful parameter for the estimation of LA blood stasis in patients with paroxysmal atrial fibrillation.
authors.affiliation: Cardiovascular Center, Sakurabashi Watanabe Hospital, 2-4-32, Umeda, Kita-ku, Osaka 530-0001, Japan. masuda101@cardiology.med.osaka-u.ac.jp
authors.forename: Masaharu
authors.initials: M
authors.lastname: Masuda
authors.forename: Katsuomi
authors.initials: K
authors.lastname: Iwakura
authors.forename: Koichi
authors.initials: K
authors.lastname: Inoue
authors.forename: Atsunori
authors.initials: A
authors.lastname: Okamura
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Koyama
authors.forename: Yuko
authors.initials: Y
authors.lastname: Toyoshima
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Tanaka
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakanishi
authors.forename: Yohei
authors.initials: Y
authors.lastname: Sotomi
authors.forename: Issei
authors.initials: I
authors.lastname: Komuro
authors.forename: Kenshi
authors.initials: K
authors.lastname: Fujii
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D001783:Blood Flow Velocity / Q000502:physiology*; D003971:Diastole; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D012680:Sensitivity and Specificity
keywords: Blood stasis; Left atrium; Mitral annular velocity; Spontaneous echo contrast; Thrombus