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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

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Abstract

Purpose

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/m2), 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.

Conclusion

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.

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Acknowledgments

This study received no grants from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Clinical Laboratory, Hiroshima Prefectural Hospital, Hiroshima, Japan

    Naoyasu Yoshida & Kiyomi Nanba

  2. Department of Cardiology, Hiroshima Prefectural Hospital, Hiroshima, Japan

    Mitsunori Okamoto, Hidekazu Hirao, Kazuyoshi Suenari, Mio Uchida, Ryo Yamazato, Yuichiro Watari, Yukihiro Fukuda & Hironori Ueda

  3. Echocardiography Division of Clinical Laboratory, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda, Minami-Ku, Hiroshima, 734-8530, Japan

    Naoyasu Yoshida

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  1. Naoyasu Yoshida
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  2. Mitsunori Okamoto
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Correspondence to Naoyasu Yoshida.

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Yoshida, N., Okamoto, M., Hirao, H. et al. 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. J Med Ultrasonics 43, 175–183 (2016). https://doi.org/10.1007/s10396-015-0688-3

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  • DOI: https://doi.org/10.1007/s10396-015-0688-3

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