title: The value of diastolic function parameters in the prediction of left atrial appendage thrombus in patients with nonvalvular atrial fibrillation.
abstract: BACKGROUND
  Left ventricular diastolic impairment and consequently elevated filling pressure may contribute to stasis leading to left atrial appendage thrombus (LAAT) in nonvalvular atrial fibrillation (AF). We investigated whether transthoracic echocardiographic parameters can predict LAAT independent of traditional clinical predictors.
  
  
  METHODS
  We conducted a retrospective cohort study of 297 consecutive nonvalvular AF patients who underwent transthoracic echocardiogram followed by a transesophageal echocardiogram within one year. Multivariate logistic regression analysis models were used to determine factors independently associated with LAAT.
  
  
  RESULTS
  Nineteen subjects (6.4%) were demonstrated to have LAAT by transesophageal echocardiography. These patients had higher mean CHADS2 scores [2.6 ± 1.2 vs. 1.9 ± 1.3, P = 0.009], higher E:e' ratios [16.6 ± 6.1 vs. 12.0 ± 5.4, P = 0.001], and lower mean e' velocities [6.5 ± 2.1 cm/sec vs. 9.1 ± 3.2 cm/sec, P = 0.001]. Both E:e' and e' velocity were associated with LAAT formation independent of the CHADS2 score, warfarin therapy, left ventricular ejection fraction (LVEF), and left atrial volume index (LAVI) [E:e' odds-ratio = 1.14 (95% confidence interval = 1.03 - 1.3), P = 0.009; e' velocity odds-ratio = 0.68 (95% confidence interval = 0.5 - 0.9), P = 0.007]. Similarly, diastolic function parameters were independently associated with spontaneous echo contrast.
  
  
  CONCLUSIONS
  The diastolic function indices E:e' and e' velocity are independently associated with LAAT in nonvalvular AF patients and may help identify patients at risk for LAAT.
authors.affiliation: Division of Cardiology, Rush University Medical Center, 1653 W, Congress Pkwy, Chicago, IL 60612, USA. rami_doukky@rush.edu.
authors.forename: Rami
authors.initials: R
authors.lastname: Doukky
authors.forename: Enrique
authors.initials: E
authors.lastname: Garcia-Sayan
authors.forename: Heather
authors.initials: H
authors.lastname: Gage
authors.forename: Vijaiganesh
authors.initials: V
authors.lastname: Nagarajan
authors.forename: Anna
authors.initials: A
authors.lastname: Demopoulos
authors.forename: Marek
authors.initials: M
authors.lastname: Cena
authors.forename: Noreen T
authors.initials: NT
authors.lastname: Nazir
authors.forename: George J
authors.initials: GJ
authors.lastname: Karam
authors.forename: Richard G
authors.initials: RG
authors.lastname: Trohman
authors.forename: Rasa
authors.initials: R
authors.lastname: Kazlauskaite
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000503:physiopathology; D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology*