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High risk of cardiogenic cerebral embolism for very elderly patients in sinus rhythm with left atrial appendage flow velocity below 50 cm/s
Author(s) -
Watanabe Daisuke,
Shizuka Kazuhiko,
Iwamoto Toshihiko
Publication year - 2007
Publication title -
geriatrics and gerontology international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.823
H-Index - 57
eISSN - 1447-0594
pISSN - 1444-1586
DOI - 10.1111/j.1447-0594.2007.00384.x
Subject(s) - medicine , sinus rhythm , atrial fibrillation , cardiology , appendage , cardioversion , thrombus , embolism , anatomy
Recent clinical trials have demonstrated that patients in sinus rhythm after cardioversion are still at risk of suffering from embolic events, but the precise mechanisms underlying the occurrence of cardiogenic cerebral embolism remain to be determined. All 72 patients aged 75 or over who were consecutively referred to our department between October 2003 and March 2006 were divided into three groups; these were: group 1, 17 patients in sinus rhythm after cardioversion; group 2, 18 patients without any history of atrial fibrillation; and group 3, 37 patients with chronic atrial fibrillation. Using transesophageal echocardiography, we evaluated the left atrial appendage flow velocity, left atrial appendage dimension, spontaneous echocardiographic contrast in the left atrium, and the presence of thrombus in the left atrial appendage. Left atrial appendage flow velocity was significantly lower in group 1 compared with group 2 (38.2 ± 6.1 vs 61.4 ± 7.4 cm/s, P < 0.001), but was even lower in group 3 (25.1 ± 9.8 cm/s, P < 0.001 vs group 1). Spontaneous echocardiographic contrast in the left atrium, thrombus in the left atrial appendage and cardiogenic cerebral embolism showed a close relationship with left atrial appendage flow velocity, and were more frequent when left atrial appendage flow velocity was less than 50 cm/s. Very elderly patients in long‐term maintenance of sinus rhythm with an left atrial appendage flow velocity of less than 50 cm/s would have a high risk of cardiogenic cerebral embolism.