title: Relevance of transthoracic left atrial appendage wall velocity measurement in addition to left atrial volume for noninvasive and quantitative assessment of left atrial thrombogenesis in patients with atrial fibrillation and normal D-dimer levels.
abstract: OBJECTIVE
  This study examined the role of left atrial (LA) appendage wall velocity (LAAWV) measurement in addition to LA size for the noninvasive assessment of thrombogenesis in patients with atrial fibrillation (AF) and normal plasma D-dimer levels.
  
  
  METHODS
  In 58 non-valvular AF patients, LAAWV and the LA volume index (LAVI) were determined by transthoracic echocardiography. LA appendage flow velocity and severity of spontaneous echo contrast (SEC) were determined by transesophageal echocardiography.
  
  
  RESULTS
  LAAWV was strongly correlated with LA appendage flow velocity (r = 0.82), and LAVI was weakly correlated with LA appendage flow velocity (r = -0.37). As SEC severity increased, LAAWV decreased (p < 0.001) and LAVI increased (p < 0.001). Among 52 patients with normal D-dimer levels, LAAWV < 10 cm/s had 71 % sensitivity and 94 % specificity for diagnosing severe SEC. Severe SEC was not found in 18/32 large LAVI patients (>34 mL/m(2)), but 17 of the 18 patients (94 %) had LAAWV < 10 cm/s. Severe SEC was found in 3/20 patients with normal LAVI, but all of them showed LAAWV < 10 cm/s.
  
  
  CONCLUSIONS
  The noninvasive measurement of transthoracic LAAWV in addition to LA volume is clinically relevant for quantitatively assessing thrombogenesis in AF patients with normal D-dimer levels.
authors.affiliation: Department of Clinical Laboratory, Hiroshima Prefectural Hospital, Hiroshima, Japan. n_yoshida0210@ybb.ne.jp.|Echocardiography Division of Clinical Laboratory, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda, Minami-Ku, Hiroshima, 734-8530, Japan. n_yoshida0210@ybb.ne.jp.
authors.forename: Naoyasu
authors.initials: N
authors.lastname: Yoshida
authors.affiliation: Department of Cardiology, Hiroshima Prefectural Hospital, Hiroshima, Japan.
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Okamoto
authors.affiliation: Department of Cardiology, Hiroshima Prefectural Hospital, Hiroshima, Japan.
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Hirao
authors.affiliation: Department of Cardiology, Hiroshima Prefectural Hospital, Hiroshima, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Suenari
authors.affiliation: Department of Clinical Laboratory, Hiroshima Prefectural Hospital, Hiroshima, Japan.
authors.forename: Kiyomi
authors.initials: K
authors.lastname: Nanba
authors.affiliation: Department of Cardiology, Hiroshima Prefectural Hospital, Hiroshima, Japan.
authors.forename: Mio
authors.initials: M
authors.lastname: Uchida
authors.affiliation: Department of Cardiology, Hiroshima Prefectural Hospital, Hiroshima, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Yamazato
authors.affiliation: Department of Cardiology, Hiroshima Prefectural Hospital, Hiroshima, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Watari
authors.affiliation: Department of Cardiology, Hiroshima Prefectural Hospital, Hiroshima, Japan.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Fukuda
authors.affiliation: Department of Cardiology, Hiroshima Prefectural Hospital, Hiroshima, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Ueda
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology*; D016279:Atrial Function, Left / Q000502:physiology; D001783:Blood Flow Velocity; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D008297:Male; D009929:Organ Size; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: Atrial fibrillation; D-dimer; Echocardiography; Left atrial volume; Spontaneous echo contrast