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Incremental value of left atrial mechanical dispersion over CHA 2 DS 2 ‐ VAS c score in predicting risk of thrombus formation
Author(s) -
Kupczynska Karolina,
Michalski Blazej W.,
Miskowiec Dawid,
Kasprzak Jaroslaw D.,
Szymczyk Ewa,
Wejner−Mik Paulina,
Lipiec Piotr
Publication year - 2018
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.13899
Subject(s) - cardiology , medicine , ejection fraction , asynchrony (computer programming) , ventricle , thrombus , atrial fibrillation , speckle tracking echocardiography , area under the curve , receiver operating characteristic , heart failure , computer network , asynchronous communication , computer science
Purpose To assess the potential ability of two‐dimensional speckle tracking analysis ( STE ) during atrial fibrillation ( AF ) to identify patients with LA appendage thrombi ( LAAT ). Methods This study involved 93 patients with AF (39% female, 67.1 ± 9.5 years) who were referred for a clinical indication for transesophageal echocardiography ( TEE ). TEE revealed LAAT in 39 (42%) patients. We analyzed standard parameters of the left ventricle ( LV ) and LA in transthoracic echocardiography. Using STE , we assessed LV global longitudinal strain ( LVGLS ), peak atrial longitudinal strain ( PALS ), and intra‐atrial asynchrony. The PALS was calculated using the global strain curve ( GPALS ) and as the mean of peaks derived from segmental strain curves ( MPALS ). Results Patients were comparable with regard to the clinical data. A subgroup with LAAT had lower LV ejection fraction ( LVEF ) and a lower absolute value of the LVGLS , as well as greater impairment in the LA standard parameters, PALS , and asynchrony. Receiver operating characteristic curve analysis revealed that the LVEF of 30% ( P < .001), the LVGLS of −7% ( P < .0001), the GPALS of 11% ( P < .005), and the LA asynchrony of 22% ( P < .01) were the optimal cutoff values for distinguishing both subgroups. LA asynchrony, LVEF , and LVGLS were independently associated with the presence of LAAT in multivariate analyses, and PALS had additional significance over the CHA 2 DS 2 ‐ VAS c score. Conclusions Left ventricular systolic dysfunction characterized by both LVEF and LVGLS is an independent factor for LAAT . LA asynchrony provides additional diagnostic value for discriminating between patients with and without LAAT .