Skip to main content
SpringerLink
Log in

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

  • original article
  • Published:
Wiener klinische Wochenschrift Aims and scope Submit manuscript

Summary

Background

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.

Methods

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.

Results

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.

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Zabalgoitia M, Halperin JL, Pearce LA, Blackshear JL, Asinger RW, Hart RG, Stroke Prevention in Atrial Fibrillation III Investigators. Transesophageal echocardiographic correlates of clinical risk of thromboembolism in nonvalvular atrial fibrillation. J Am Coll Cardiol. 1998;31(7):1622–6. https://doi.org/10.1016/S0735-1097(98)00146-6.

    Article  CAS  PubMed  Google Scholar 

  2. Reisner SA, Lysyansky P, Agmon Y, Mutlak D, Lessick J, Friedman Z. Global longitudinal strain: a novel index of left ventricular systolic function. J Am Soc Echocardiogr. 2004;17(6):630–3. https://doi.org/10.1016/j.echo.2004.02.011.

    Article  PubMed  Google Scholar 

  3. Bertini M, Ng AC, Antoni ML, Nucifora G, Ewe SH, Auger D, et al. Global longitudinal strain predicts long-term survival in patients with chronic ischemic cardiomyopathy. Circ Cardiovasc Imaging. 2012;5(3):383–91. https://doi.org/10.1161/CIRCIMAGING.111.970434.

    Article  PubMed  Google Scholar 

  4. Buss SJ, Emami M, Mereles D, Korosoglou G, Kristen AV, Voss A, et al. Longitudinal left ventricular function for prediction of survival in systemic light-chain amyloidosis: incremental value compared with clinical and biochemical markers. J Am Coll Cardiol. 2012;60(12):1067–76. https://doi.org/10.1016/j.jacc.2012.04.043.

    Article  PubMed  Google Scholar 

  5. Kearney LG, Lu K, Ord M, Patel SK, Profitis K, Matalanis G, et al. Global longitudinal strain is a strong independent predictor of all-cause mortality in patients with aortic stenosis. Eur Heart J Cardiovasc Imaging. 2012;13(10):827–33. https://doi.org/10.1093/ehjci/jes115.

    Article  CAS  PubMed  Google Scholar 

  6. Takahashi N, Nakamura Y, Komatsu S, Kusano KF, Ohe T. The feasibility of tissue Doppler acceleration as a new predictor of thrombogenesis in the left atrial appendage associated with nonvalvular atrial fibrillation. Echocardiography. 2008;25(1):64–71. https://doi.org/10.1111/j.1540-8175.2007.00565.x.

    Article  PubMed  Google Scholar 

  7. Miyoshi A, Nakamura Y, Kazatani Y, Ito H. The feasibility of substituting left atrial wall strain for flow velocity of left atrial appendage. Acta Cardiol. 2017;73(2):125–30. https://doi.org/10.1080/00015385.2017.1351242.

    Article  PubMed  Google Scholar 

  8. Sevimli S, Gundogdu F, Arslan S, Aksakal E, Gurlertop HY, Islamoglu Y, Tas H, Acikel M, Erol MK, Senocak H, Karakelleoglu S, Atesal S, Alp N. Strain and strain rate imaging in evaluating left atrial appendage function by transesophageal echocardiography. Echocardiography. 2007;24(8):823–9. https://doi.org/10.1111/j.1540-8175.2007.00469.x.

    Article  PubMed  Google Scholar 

  9. Kurzawski J, Janion-Sadowska A, Sadowski M. Left atrial appendage function assessment and thrombus identification. Int J Cardiol Heart Vasc. 2016;14:33–40. https://doi.org/10.1016/j.ijcha.2016.11.003.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16(3):233–70. https://doi.org/10.1016/j.echo.2014.10.003.

    Article  PubMed  Google Scholar 

  11. Flachskampf FA, Wouters PF, Edvardsen T, Evangelista A, Habib G, Hoffman P, Hoffmann R, Lancellotti P, Pepi M, European Association of Cardiovascular Imaging Document reviewers: E Donal and F Rigo. Recommendations for transoesophageal echocardiography: EACVI update 2014. Eur Heart J Cardiovasc Imaging. 2014;15(4):353–65. https://doi.org/10.1093/ehjci/jeu015.

    Article  PubMed  Google Scholar 

  12. Romero JR, Wolf PA. Epidemiology of stroke: legacy of the Framingham heart study. Glob Heart. 2013;8(1):67–75. https://doi.org/10.1016/j.gheart.2012.12.007.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Welch W. A system of medicine. 2nd ed. London: MacMillan and Co, Ltd; 1909.

    Google Scholar 

  14. The Boston Area Anticoagulation Trial for Atrial Fibrillation Investigators. The effect of low-dose warfarin on the risk of stroke in patients with nonrheumatic atrial fibrillation. N Engl J Med. 1990;323:1505–11. https://doi.org/10.1056/NEJM199011293232201.

    Article  Google Scholar 

  15. Connolly SJ, Laupacis A, Gent M, Roberts RS, Cairns JA, Joyner C. Canadian Atrial Fibrillation Anticoagulation (CAFA) Study. J Am Coll Cardiol. 1991;18:349–55. https://doi.org/10.1016/0735-1097(91)90585-W.

    Article  CAS  PubMed  Google Scholar 

  16. EAFT (European Atrial Fibrillation Trial) Study Group. Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. Lancet. 1993;342:1255–62. https://doi.org/10.1016/0140-6736(93)92358-Z.

    Article  Google Scholar 

  17. Atrial Fibrillation Investigators. Stroke prevention in atrial fibrillation study. Final results. Circulation. 1991;84:527–39. https://doi.org/10.1161/01.CIR.84.2.527.

    Article  Google Scholar 

  18. Ezekowitz MD, Bridgers SL, James KE, Nonrheumatic Atrial Fibrillation Investigators, et al. Warfarin in the prevention of stroke associated with nonrheumatic atrial fibrillation. N Engl J Med. 1992;327:1406–12. https://doi.org/10.1056/NEJM199211123272002.

    Article  CAS  PubMed  Google Scholar 

  19. Di Minno MN, Ambrosino P, Dello Russo A, Casella M, Tremoli E, Tondo C. Prevalence of left atrial thrombus in patients with non-valvular atrial fibrillation. A systematic review and meta-analysis of the literature. Thromb Haemost. 2016;115(3):663–77. https://doi.org/10.1160/TH15-07-0532.

    Article  PubMed  Google Scholar 

  20. Beigel R, Wunderlich NC, Ho SY, Arsanjani R, Siegel RJ. The left atrial appendage: anatomy, function, and noninvasive evaluation. Jacc Cardiovasc Imaging. 2014;7(12):1251–65. https://doi.org/10.1016/j.jcmg.2014.08.009.

    Article  PubMed  Google Scholar 

  21. Shirani J, Alaeddini J. Structural remodeling of the left atrial appendage in patients with chronic non-valvular atrial fibrillation: implications for thrombus formation, systemic embolism, and assessment by transesophageal echocardiography. Cardiovasc Pathol. 2000;9(2):95–101. https://doi.org/10.1016/S1054-8807(00)00030-2.

    Article  CAS  PubMed  Google Scholar 

  22. Potter E, Marwick TH. Assessment of left ventricular function by Echocardiography: the case for routinely adding global longitudinal strain to ejection fraction. Jacc Cardiovasc Imaging. 2018;11(2 Pt 1):260–74. https://doi.org/10.1016/j.jcmg.2017.11.017.

    Article  PubMed  Google Scholar 

  23. Hinton RC, Kistler JP, Fallon JT, Friedlich AL, Fisher CM. Influence of etiology of atrial fibrillation on incidence of systemic embolism. Am J Cardiol. 1977;40(4):509–13. https://doi.org/10.1016/0002-9149(77)90064-9.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. East-Slovak Institute of Cardiovascular Diseases and Medical Faculty of Safarik University, Department of Cardiology, Safarik University, Ondavska 8, 040 11, Kosice, Slovakia

    Monika Jankajova M.D., PhD, Lucia Kubikova M.D.,  Gabriel Valocik M.D., PhD,  Peter Mitro M.D., PhD, Marian Kurecko M.D., Marianna Vachalcova M.D., PhD & Marianna Dvoroznakova M.D.

  2. East-Slovak Institute of Cardiovascular Diseases and Medical Faculty of Safarik University, Department of Anesthesiology and Intensive Medicine, Safarik University, Kosice, Slovakia

    Peter Candik M.D., PhD

  3. East-Slovak Institute of Cardiovascular Diseases and Medical Faculty of Safarik University, Department of Cardiac Surgery, Safarik University, Kosice, Slovakia

    Frantisek Sabol M.D., PhD, MPH, MBA & Adrian Kolesar M.D, PhD, MPH

  4. East-Slovak Institute of Cardiovascular Diseases and Medical Faculty of Safarik University, Department of Vascular Surgery, Safarik University, Kosice, Slovakia

    Maria Kubikova M.D., PhD

Authors
  1. Monika Jankajova M.D., PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lucia Kubikova M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gabriel Valocik M.D., PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peter Candik M.D., PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Peter Mitro M.D., PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marian Kurecko M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Frantisek Sabol M.D., PhD, MPH, MBA
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Adrian Kolesar M.D, PhD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Maria Kubikova M.D., PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Marianna Vachalcova M.D., PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Marianna Dvoroznakova M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lucia Kubikova M.D..

Ethics declarations

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.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jankajova, M., Kubikova, L., Valocik, G. et al. Left atrial appendage strain rate is associated with documented thromboembolism in nonvalvular atrial fibrillation. Wien Klin Wochenschr 131, 156–164 (2019). https://doi.org/10.1007/s00508-019-1469-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00508-019-1469-6

Keywords

Search

Navigation