Journal of the American Society of Echocardiography
Volume 23, Issue 5 , Pages 545-552.e1, May 2010

Low Wall Velocity of Left Atrial Appendage Measured by Trans-Thoracic Echocardiography Predicts Thrombus Formation Caused by Atrial Appendage Dysfunction

  • Harutoshi Tamura, MD

      Affiliations

    • Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
    • ,
  • Tetsu Watanabe, MD

      Affiliations

    • Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
    • Corresponding Author InformationReprint requests: Tetsu Watanabe, MD, PhD, Yamagata University School of Medicine, Department of Cardiology, Pulmonology, and Nephrology, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.
    • ,
  • Osamu Hirono, MD

      Affiliations

    • Yamagata Prefectural Shinjo Hospital, Yamagata, Japan
    • ,
  • Satoshi Nishiyama, MD

      Affiliations

    • Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
    • ,
  • Shintaro Sasaki, MD

      Affiliations

    • Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
    • ,
  • Tetsuro Shishido, MD

      Affiliations

    • Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
    • ,
  • Takehiko Miyashita, MD

      Affiliations

    • Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
    • ,
  • Takuya Miyamoto, MD

      Affiliations

    • Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
    • ,
  • Joji Nitobe, MD

      Affiliations

    • Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
    • ,
  • Takamasa Kayama, MD

      Affiliations

    • Department of Neurosurgery, Yamagata University School of Medicine, Yamagata, Japan
    • ,
  • Isao Kubota, MD

      Affiliations

    • Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan

published online 01 April 2010.

Background

Atrial fibrillation is associated with ischemic stroke because of thrombi that form within the left atrial appendage (LAA). The aim of this study was to develop a new parameter for LAA function that is easily performed using transthoracic echocardiography (TTE).

Methods

TTE and transesophageal echocardiography were performed in 106 patients with stroke. LAA wall motion velocity (TTE-LAWV) was measured using Doppler tissue imaging at the LAA tip.

Results

TTE-LAWV was significantly lower in patients with atrial fibrillation and LAA thrombus than in those with atrial fibrillation and no LAA thrombus and in sinus rhythm (7.5 ± 1.9 vs 10.0 ± 3.4 and 13.8 ± 5.7 cm/s, respectively, P < .05). TTE-LAWV was significantly correlated with LAA emptying flow velocity (R = 0.462, P < .05). The multivariate logistic regression analysis showed that TTE-LAWV < 8.7 cm/s was an independent predictor of LAA thrombus formation (odds ratio, 9.473; 95% confidence interval, 1.172-76.55; P < .05).

Conclusion

TTE-LAWV can noninvasively evaluate LAA dysfunction and assist in the detection of LAA thrombus.

Keywords: Left atrial appendage wall motion, Left atrial appendage thrombus, Noninvasive

Abbreviations: AF, Atrial fibrillation, LAA, Left atrial appendage, LAA eV, LAA emptying flow velocity, LAD, Left atrial dimension, LAWV, LAA peak wall velocity, ROC, Receiver operating characteristic, SEC, Spontaneous echocardiographic contrast, TEE, Transesophageal echocardiography, TTE, Transthoracic echocardiography

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 This work was supported by a grant-in-aid from the Global COE program of the Japan Society for the Promotion of Science and by a grant from the Ministry of Education, Culture, Sports, Science and Technology of Japan (grants 19790513, 19790515, and 20590813).

PII: S0894-7317(10)00139-2

doi:10.1016/j.echo.2010.02.006

Journal of the American Society of Echocardiography
Volume 23, Issue 5 , Pages 545-552.e1, May 2010

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