scholarly journals Increased Serum Uric Acid Levels Are Correlated with Decreased Left Atrial Appendage Peak Flow Velocity in Patients with Atrial Fibrillation

2015 ◽  
Vol 24 (3) ◽  
pp. 263-268 ◽  
Author(s):  
Murat Celik ◽  
Emre Yalcinkaya ◽  
Uygar Cagdas Yuksel ◽  
Yalcin Gokoglan ◽  
Baris Bugan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Uric Acid ◽  
Flow Velocity ◽  
Serum Uric Acid ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Peak Flow ◽  
Atrial Appendage ◽  
Peak Flow Velocity

Abstract WMP66: Left Atrial Appendage Flow Velocity is Associated With Ischemic Events and Brain Infarcts in Atrial Fibrillation

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Gian C Ignacio ◽  
Andrew D Chang ◽  
Nikhil C Panda ◽  
Antony Chu ◽  
Michael Wu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Flow Velocity ◽  
Left Atrial ◽  
Primary Outcome ◽  
Left Atrial Appendage ◽  
Peak Flow ◽  
Atrial Appendage ◽  
Clinical Predictors ◽  
Low Velocity ◽  
Ischemic Events

Objective: Clinical predictors of ischemic stroke in the setting of atrial fibrillation (AF) have been identified, but there is limited data on predictors in the context of abnormal flow originating from the left atrial appendage. We hypothesize that reduced LAA flow velocity is associated with cerebrovascular ischemic events in patients with AF. Methods: We investigated consecutive patients with AF evaluated for ablation. Peak flow velocities at the orifice of the left atrial appendage (LAA) were obtained by transeosphageal echocardiography (TEE) studies, and elevated velocities were defined as greater than 40 cm/sec, in line with prior studies. The primary outcome was defined as the presence of any of the following: history of stroke/transient ischemic event, or non-lacunar brain infarct on brain imaging performed before the TEE. Univariate and multivariable analyses were performed to determine the association between LAA peak flow and the primary outcome, adjusting for CHADS2Vasc score. Results: We identified 322 patients with TEE performed. The mean age was 62.1 years and 24.5% men. Patients with LAA-flow velocity < 40 cm/sec were more likely to have the primary outcome (10.7% vs 4.3%, p=0.023). This association persisted after adjusting for CHADS2VASc (OR, 2.62; 95% CI, 1.09-6.33, p = 0.032). Conclusion: Low velocity in the LAA is associated with cerebrovascular ischemic events in patients with AF. More studies are needed to deterine whether LAA flow velocity can help risk stratify “low risk” patients with AF.

scholarly journals Left atrial appendage orifice area and morphology is closely associated with flow velocity in patients with nonvalvular atrial fibrillation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lei Chen ◽  
Changjiang Xu ◽  
Wensu Chen ◽  
Chaoqun Zhang
Keyword(s):  
Atrial Fibrillation ◽  
Flow Velocity ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Linear Regression Analysis ◽  
Left Ventricular ◽  
Atrial Appendage ◽  
Mechanical Function ◽  
Orifice Area ◽  
The Relationship

Abstract Background Thromboembolic events are the most serious complication of atrial fibrillation (AF), and the left atrial appendage (LAA) is the most important site of thrombosis in patients with AF. During the period of COVID-19, a non-invasive left atrial appendage detection method is particularly important in order to reduce the exposure of the virus. This study used CT three-dimensional reconstruction methods to explore the relationship between LAA morphology, LAA orifice area and its mechanical function in patients with non-valvular atrial fibrillation (NVAF). Methods A total of 81 consecutive patients with NVAF (36 cases of paroxysmal atrial fibrillation and 45 cases of persistent atrial fibrillation) who were planned to undergo catheter radiofrequency ablation were enrolled. All patients were examined by transthoracic echocardiography (TTE), TEE, and computed tomography angiography (CTA) before surgery. The LAA orifice area was obtained according to the images of CTA. According to the left atrial appendage morphology, it was divided into chicken wing type and non-chicken wing type. At the same time, TEE was performed to determine left atrial appendage flow velocity (LAAFV), and the relationship between the left atrial appendage orifice area and LAAFV was analyzed. Results The LAAFV in Non-chicken wing group was lower than that in Chicken wing group (36.2 ± 15.0 cm/s vs. 49.1 ± 22.0 cm/s, p-value < 0.05). In the subgroup analysis, the LAAFV in Non-chicken wing group was lower than that in Chicken wing group in the paroxysmal AF (44.0 ± 14.3 cm/s vs. 60.2 ± 22.8 cm/s, p-value < 0.05). In the persistent AF, similar results were observed (29.7 ± 12.4 cm/s vs. 40.8 ± 17.7 cm/s, p-value < 0.05). The LAAFV in persistent AF group was lower than that in paroxysmal AF group (34.6 ± 15.8 cm/s vs. 49.9 ± 20.0 cm/s, p-value < 0.001). The LAAFV was negatively correlated with left atrial dimension (R = − 0.451, p-value < 0.001), LAA orifice area (R= − 0.438, p-value < 0.001) and left ventricular mass index (LVMI) (R= − 0.624, p-value < 0.001), while it was positively correlated with LVEF (R = 0.271, p-value = 0.014). Multiple linear regression analysis showed that LAA morphology (β = − 0.335, p-value < 0.001), LAA orifice area (β = −  0.185, p-value = 0.033), AF type (β = − 0.167, p-value = 0.043) and LVMI (β = − 0.465, p-value < 0.001) were independent factors of LAAFV. Conclusions The LAA orifice area is closely related to the mechanical function of the LAA in patients with NVAF. The larger LAA orifice area and LVMI, Non-chicken wing LAA and persistent AF are independent predictors of decreased mechanical function of LAA, and these parameters might be helpful for better management of LA thrombosis.

Abstract WP260: The Left Atrial Appendage Morphology Improves Prediction of Appendage Stagnant Flow and Stroke Risk in Patients With Atrial Fibrillation Using a Simple Classification System

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Shadi Yaghi ◽  
Andrew Chang ◽  
Gian Ignacio ◽  
Erica Scher ◽  
Nikhil Panda ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Flow Velocity ◽  
Primary Endpoint ◽  
Classification System ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Current System ◽  
Classification Systems ◽  
Atrial Appendage ◽  
Simple Classification

Background and Purpose: Previously we proposed a simple classification system of the left atrial appendage (LAA) morphology, with low risk (LAA-L) defined as one lobe with an acute angle bend arising from the proximal or middle portion and high risk (LAA-H) defined as all other morphologies. We aim to determine the association between LAA morphology (using both classification systems), LAA flow velocity, and stroke rates. Methods: We analyzed consecutive patients with atrial fibrillation (AF) selected for ablation who underwent cardiac CT angiography and transesophageal echocardiogram. The primary correlates were LAA-H and non-chicken wing (NCW) LAA morphology. The primary outcome was the composite endpoint of history of ischemic stroke/TIA or non-lacunar infarct on neuroimaging. Adjusting for CHADS2Vasc score, multivariable models were used to determine associations between LAA morphology and composite outcomes. Results: We identified 379 patients; the primary endpoint occurred in 32/379 patients (8.4%). LAA-H (adjusted OR 3.63, 95% CI 1.44-9.14) and NCW LAA morphology (adjusted OR 2.52, 95% CI 1.15-5.53) were associated with the primary endpoint. LAA flow velocity ≤20 cm/s was more common in LAA-H vs. LAA-L (9.6% vs. 2.8%, p = 0.019), but not in NCW vs. CW LAA morphology (9.7% vs. 3.7%, p = 0.054). Conclusion: The LAA H/L morphological classification system may be superior to the current system in risk stratifying patients with AF and correlates better with impaired LAA flow dynamics.

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