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Assessment of left atrial appendage function by transthoracic pulsed Doppler echocardiography: Comparing against transesophageal interrogation and predicting echocardiographic risk factors for stroke
Author(s) -
Wai Shin Hnin,
Kyu Kyu,
Galupo Mary Joyce,
Songco Geronica G.,
Kong William K. F.,
Lee Chi Hang,
Yeo Tiong Cheng,
Poh Kian Keong
Publication year - 2017
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13659
Subject(s) - medicine , thrombus , cardiology , atrial fibrillation , risk stratification , cutoff , stroke (engine) , transesophageal echocardiogram , doppler effect , doppler echocardiography , radiology , diastole , mechanical engineering , physics , quantum mechanics , astronomy , engineering , blood pressure
Aims Transesophageal echocardiographic ( TEE ) findings of left atrial appendage ( LAA ) thrombus, spontaneous echo contrast ( SEC ), and LAA dysfunction are established risk factors of cardioembolic stroke. The semi‐invasive nature of TEE limits its utility as a routine risk stratification tool. We aim to correlate TEE and transthoracic echocardiography ( TTE ) pulsed Doppler measurements of LAA flow velocities and use TTE measurements to predict TEE findings. Methods and Results We prospectively measured pulsed Doppler LAA flow velocities in 103 consecutive patients on TEE and TTE . There was a strong correlation between TEE and TTE LAA emptying velocity ( LAA E ) ( r = .88, P < .001) and a moderate correlation between LAA filling velocities ( r = .50, P < .001). TTE LAA E predicted the presence of thrombus or SEC independent of atrial fibrillation (AF). To predict the presence of thrombus or SEC , the optimal TTE LAA E cutoff was ≤30 cm/s in all patients (75% sensitive, 90% specific) and ≤31 cm/s in AF patients (80% sensitive, 79% specific). To predict LAA dysfunction ( TEE E ≤ 20 cm/s), the optimal TTE LAA E cutoff was ≤27 cm/s (100% sensitive, 89% specific in all patients and 100% sensitive, 74% specific in AF patients). Conclusions TTE assessment of LAA function is feasible and correlates well with the more invasive TEE method. It predicts the presence of thrombus, SEC , and LAA dysfunction on TEE . TTE LAA assessment has incremental value in thromboembolic risk stratification and should be utilized more frequently.