Wiener klinische Wochenschrift

, Volume 131, Issue 7–8, pp 156–164 | Cite as

Left atrial appendage strain rate is associated with documented thromboembolism in nonvalvular atrial fibrillation

  • Monika Jankajova
  • Lucia KubikovaEmail author
  • Gabriel Valocik
  • Peter Candik
  • Peter Mitro
  • Marian Kurecko
  • Frantisek Sabol
  • Adrian Kolesar
  • Maria Kubikova
  • Marianna Vachalcova
  • Marianna Dvoroznakova
original article



The left atrial appendage (LAA) strain and strain rate have not yet been studied in the prediction of cardiac thromboembolism. Therefore, this study aimed to evaluate the significance of LAA strain and strain rate as assessed by speckle-tracking imaging in relation to documented thromboembolic events.


A group of 80 patients with a mean age of 65 years who were referred for electrical cardioversion of nonvalvular atrial fibrillation was retrospectively analyzed. Each patient underwent 2D transesophageal echocardiography (TEE). Velocity vector imaging (VVI)-derived LAA strain and strain rate in parallel with other conventional TEE predictors were analyzed in terms of their association with previous embolic stroke and peripheral embolization.


By comparing the two groups of patients with (22/80) and without embolic events (58/80), patients with embolic events were older, had higher CHA2DS2-VASc scores, higher incidence of coronary artery disease and LAA thrombi, and worse LAA strain and strain rate. Moreover, patients without embolization more often used anticoagulants than patients with embolic events. After adjusting for the abovementioned embolic risk factors, only the CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years [double weight], diabetes mellitus, stroke [double weight], vascular disease, age from 65 to 74 years, sex category) score and the LAA strain rate remained as significant predictors of embolic events.


The results of the study show that the VVI-derived LAA strain rate is a significant predictor of documented ischemic stroke and systemic thromboembolism in patients with nonvalvular atrial fibrillation. Its predictive power is similar to the predictive power of the CHA2DS2-VASc score.


Velocity vector imaging Echocardiography Predictor  Dysrhythmia  Cardioversion 


Compliance with ethical guidelines

Conflict of interest

M. Jankajova, L. Kubikova, G. Valocik, P. Candik, P. Mitro, M. Kurecko, F. Sabol, A. Kolesar, M. Kubikova, M. Vachalcova and M. Dvoroznakova declare that they have no competing interests.

Ethical standards

The trial protocol involving a retrospective analysis was approved by the Ethics Committee of the Hospital and the trial was conducted in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For images or other information within the manuscript which identifies patients, consent was obtained from them and/or their legal guardians.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Monika Jankajova
    • 1
  • Lucia Kubikova
    • 1
    Email author
  • Gabriel Valocik
    • 1
  • Peter Candik
    • 2
  • Peter Mitro
    • 1
  • Marian Kurecko
    • 1
  • Frantisek Sabol
    • 3
  • Adrian Kolesar
    • 3
  • Maria Kubikova
    • 4
  • Marianna Vachalcova
    • 1
  • Marianna Dvoroznakova
    • 1
  1. 1.East-Slovak Institute of Cardiovascular Diseases and Medical Faculty of Safarik University, Department of CardiologySafarik UniversityKosiceSlovakia
  2. 2.East-Slovak Institute of Cardiovascular Diseases and Medical Faculty of Safarik University, Department of Anesthesiology and Intensive MedicineSafarik UniversityKosiceSlovakia
  3. 3.East-Slovak Institute of Cardiovascular Diseases and Medical Faculty of Safarik University, Department of Cardiac SurgerySafarik UniversityKosiceSlovakia
  4. 4.East-Slovak Institute of Cardiovascular Diseases and Medical Faculty of Safarik University, Department of Vascular SurgerySafarik UniversityKosiceSlovakia

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