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Left atrial appendage dysfunction in acute cerebral embolism patients with sinus rhythm: correlation with pulse wave tissue Doppler imaging

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Abstract

To evaluate left atrial appendage (LAA) dysfunction using left atrial pulse-wave tissue Doppler imaging (PW-TDI) in acute cerebral embolism (ACE) patients with sinus rhythm (SR), transthoracic (TTE) and transesophageal echocardiograhy (TEE) were performed in 60 consecutive patients with SR without obvious left ventricular dysfunction within 2 weeks after ACE. Two groups were identified: LAA dysfunction [LAA emptying peak flow velocity (LAA-eV) <0.55 m/s, n = 20, age 65 ± 10 years] and without LAA dysfunction (LAA-eV ≥ 0.55 m/s, n = 40, age 64 ± 10 years) on TEE. Left atrial wall motion velocity (WMV) was obtained from PW-TDI, with the sample volume placed at the left atrial anterior wall adjacent to ascending aortic inferior wall from the long axis view on TTE. WMVs showed triphasic waves: after the P wave (La’) during systole (Ls’), and during early diastole. La’ and Ls’ were significantly lower in the group with versus without LAA dysfunction (4.9 ± 1.4 vs. 7.7 ± 1.8 cm/s, p < 0.0001; 5.3 ± 2.0 vs. 6.7 ± 1.9 cm/s, p < 0.001, respectively) and prevalence of paroxysmal atrial fibrillation, left atrial volume index, and serum levels of brain natriuretic peptide were significantly higher (60 vs. 15 %, p < 0.001; 32 ± 13 vs. 24 ± 13 ml/m2, p < 0.05; 174 ± 279 vs. 48 ± 68 pg/ml, p < 0.01, respectively). La’ was an independent predictor of LAA dysfunction (OR 0.380, 95 % CI 0.156–0.925, p < 0.05), and was significantly correlated with LAA-eV (r = 0.594, p < 0.0001) and LAA fractional area change (r = 0.682, p < 0.0001). The optimal cut-off value for LAA-eV < 0.55 m/s was 5.5 cm/s (sensitivity 83 %, specificity 88 %). La’ is a useful and convenient strong predictor of LAA dysfunction in ACE patients with SR.

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Abbreviations

AF:

Atrial fibrillation

LAA:

Left atrial appendage

TEE:

Transesophageal echocardiography

SEC:

Spontaneous echo contrast

LA:

Left atrium

LAA-eV:

Left atrial appendage emptying peak flow velocity

LAA-FAC:

Left atrial appendage fractional area change

PAF:

Paroxysmal atrial fibrillation

PW-TDI:

Pulse-wave tissue Doppler imaging

WMV:

Wall motion velocity

BNP:

Brain natriuretic peptide

E/A:

Mitral flow ratio of early diastolic filling velocity to atrial filling velocity

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Authors and Affiliations

  1. Department of Cardiology, Kitamurayama Municipal Hospital, 2-15-1 Onsen-machi, Higashine, Yamagata, 999-3792, Japan

    Kazuyoshi Kaneko & Hiroki Saito

  2. Department of Cardiology, Nihonkai General Hospital, 30 Akiho-cho, Sakata, 998-8501, Japan

    Yoichiro Otaki, Shinpei Kadowaki, Taro Narumi, Nobuyuki Kiribayashi, Koki Omi, Toshiki Sasaki, Takeshi Niizeki & Shigeo Sugawara

  3. Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan

    Isao Kubota

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  1. Kazuyoshi Kaneko
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  2. Yoichiro Otaki
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Correspondence to Kazuyoshi Kaneko.

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Kaneko, K., Otaki, Y., Kadowaki, S. et al. Left atrial appendage dysfunction in acute cerebral embolism patients with sinus rhythm: correlation with pulse wave tissue Doppler imaging. Int J Cardiovasc Imaging 30, 1245–1254 (2014). https://doi.org/10.1007/s10554-014-0455-3

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  • DOI: https://doi.org/10.1007/s10554-014-0455-3

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