Incremental value of left atrial mechanical dispersion over CHA 2 DS 2 ‐ VAS c score in predicting risk of thrombus formation

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 .