title: Left Atrial Remodeling Assessed by Transthoracic Echocardiography Predicts Left Atrial Appendage Flow Velocity in Patients With Paroxysmal Atrial Fibrillation.
abstract: Atrial fibrillation (AF) is associated with an increased risk of stroke and other thromboembolic events. Left atrial (LA) thrombus formation is closely related to LA dysfunction, particularly to decreased LA appendage flow velocity (LAA-FV) in patients with AF. We estimated LAA-FV using parameters noninvasively obtained by transthoracic echocardiography (TTE) in patients with paroxysmal AF.Echocardiographic and clinical parameters were assessed in 190 patients with nonvalvular paroxysmal AF showing sinus heart rhythm during transesophageal echocardiography (TEE) and TTE.LAA-FV (60 ± 22 cm/s) significantly correlated with the time interval between the initiation of the P-wave on ECG and that of the A-wave of transmitral flow on TTE (PA-TMF, correlation coefficient, -0.32; P < 0.001), LA dimension (LAD, -0.31; P < 0.001), septal a' velocity of tissue Doppler imaging (TDI, 0.35; P < 0.001), E/e' ratio (-0.28, P < 0.001), E velocity of transmitral flow (-0.20, P = 0.008), E/A ratio of transmitral flow (-0.18, P = 0.02), CHA2DS2-VASc score (-0.15, P = 0.04), and BNP plasma level (-0.32, P = 0.002). Multivariate analysis revealed that PA-TMF (standardized partial regression coefficient, -0.17; P = 0.03), a' velocity (0.24, P = 0.004), and LAD (-0.20, P = 0.01) were independent predictors of LAA-FV (multiple correlation coefficient R, 0.44; P < 0.001).Parameters of atrial remodeling, ie, decreased a' velocity, increased LAD, and PA-TMF during sinus rhythm may be useful predictors of LA blood stasis in patients with nonvalvular PAF. LAA-FV can be estimated using these TTE parameters instead of TEE.
authors.affiliation: Department of Advanced Medical Science, The Institute of Medical Science, The University of Tokyo.
authors.forename: Atai
authors.initials: A
authors.lastname: Watanabe
authors.forename: Shinya
authors.initials: S
authors.lastname: Suzuki
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kano
authors.forename: Syunsuke
authors.initials: S
authors.lastname: Matsuno
authors.forename: Hideaki
authors.initials: H
authors.lastname: Takai
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kato
authors.forename: Takayuki
authors.initials: T
authors.lastname: Otsuka
authors.forename: Tokuhisa
authors.initials: T
authors.lastname: Uejima
authors.forename: Yuji
authors.initials: Y
authors.lastname: Oikawa
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Nagashima
authors.forename: Hajime
authors.initials: H
authors.lastname: Kirigaya
authors.forename: Takashi
authors.initials: T
authors.lastname: Kunihara
authors.forename: Koichi
authors.initials: K
authors.lastname: Sagara
authors.forename: Naohide
authors.initials: N
authors.lastname: Yamashita
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sawada
authors.forename: Tadanori
authors.initials: T
authors.lastname: Aizawa
authors.forename: Junji
authors.initials: J
authors.lastname: Yajima
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamashita
mesh_terms: D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000503:physiopathology; D064752:Atrial Remodeling; D001783:Blood Flow Velocity / Q000502:physiology*; D015150:Echocardiography, Doppler / Q000379:methods*; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D013614:Tachycardia, Paroxysmal / Q000000981:diagnostic imaging* / Q000503:physiopathology