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Average e′ velocity on transthoracic echocardiogram is a novel predictor of left atrial appendage sludge or thrombus in patients with atrial fibrillation
Author(s) -
Garshick Michael S.,
Mulliken Jennifer,
Schoenfeld Matthew,
Riedy Katherine,
Guo Yu,
Zhong Judy,
Dodson John A.,
Saric Muhamed,
Skolnick Adam H.
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.14148
Subject(s) - atrial fibrillation , cardiology , thrombus , medicine , ejection fraction , transthoracic echocardiogram , transesophageal echocardiogram , diastole , heart failure , blood pressure
Background Studies have demonstrated the value of transthoracic echocardiogram (TTE) diastolic parameters in predicting left atrial appendage (LAA) thrombus; however, these studies have been small. We aim to clarify the relationship between TTE diastolic parameters, in particular average e′, and LAA thrombus or sludge. Methods A case‐control review was conducted of subjects with non‐valvular atrial fibrillation (n = 2263) who had undergone TEE (transesophageal echocardiogram) and had a TTE within 1 year of TEE. Cases of LAA sludge or thrombus were matched to controls by age, sex, left ventricular ejection fraction (LVEF), and anticoagulation status. Results Forty‐three subjects (mean age 73 ± 12, 65% male, LVEF 47%, 44% on anticoagulation) with LAA sludge or thrombus were identified. Compared to matched controls, average TTE e′ (7.3 ± 2.1 cm/s vs 8.7 ± 2.1 cm/s, P < 0.001) and the E:e′ ratio (15 ± 7 cm/s vs 12 ± 5 cm/s; P = 0.005) were significant predictors of LAA sludge or thrombus. Average TTE e′ value of >11 cm/s had 100% sensitivity for ruling out LAA sludge or thrombus. Conclusion In individuals with atrial fibrillation, average e′ >11 cm/s on TTE is a promising independent predictor of the absence of LAA sludge or thrombus on TEE.