Effects of left ventricular systolic dysfunction on left atrial appendage and left atrial functions in patients with chronic nonvalvular atrial fibrillation

2002 ◽  
Vol 57 (2) ◽  
pp. 101-105 ◽  
Author(s):  
Mustafa CEMRİ ◽  
Timur TİMURKAYNAK ◽  
Murat ÖZDEMİR ◽  
Bülent BOYACI ◽  
Rıdvan YALCIN ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Atrial Appendage ◽  
Ventricular Systolic Dysfunction ◽  
Nonvalvular Atrial Fibrillation ◽  
Atrial Functions

scholarly journals Association of CHADS2and CHA2DS2-VASc Scores with Left Atrial Thrombus with Nonvalvular Atrial Fibrillation: A Single Center Based Retrospective Study in a Cohort of 2695 Chinese Subjects

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
J. Huang ◽  
SL. Wu ◽  
YM. Xue ◽  
HW. Fei ◽  
QW. Lin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Area Under The Curve ◽  
Predictive Ability ◽  
Left Ventricular ◽  
Left Atrial Thrombus ◽  
Nonvalvular Atrial Fibrillation ◽  
Atrial Thrombus

The main mechanism of the CHADS2and CHA2DS2-VASc scores to predict stroke in nonvalvular atrial fibrillation (NVAF) is still controversial. We evaluated the association of the CHADS2and CHA2DS2-VASc scores with left atrial thrombus (LAT) as detected by transesophageal echocardiographic (TEE) and compared the predictive ability of these risk stratification schemes with nonvalvular atrial fibrillation (NVAF). Data from 2,695 consecutive NVAF patients in whom TEE was performed for screening LAT from July 2007 to February 2014 were analyzed. Only 3% of the subjects had LAT. Presence of LAT was not significantly associated with either CHADS2  (P=0.07)or CHA2DS2-VASc score(P=0.12). The area under the curve (AUC) concerning LAT prediction using CHADS2and CHA2DS2-VASc was 0.574 and 0.569, respectively. A composition model includes previous stroke or transient ischemic attack, nonparoxysmal AF, moderate to severe left ventricular systolic dysfunction, left atrial enlargement, and cardiomyopathy which improved the discrimination significantly (AUC = 0.743). In our cohort, both CHADS2and CHA2DS2-VASc scores were of limited value for predicting LAT in patients with NVAF. This questions the CHADS2/CHA2DS2-VASc score predicting stroke mainly through the mechanism of cardiogenic embolism. A scoring scheme combining clinical and echocardiographic parameters may better predict LAT as a surrogate for cardioembolic risk in NVAF patients.

P3774Prediction of left atrial appendage thrombosis in nonvalvular atrial fibrillation by means of predictors not related to CHA2DS2-VASc score

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Gizatulina ◽  
N Y Khorkova ◽  
A V Belokurova ◽  
V E Kharats ◽  
L U Martyanova
Keyword(s):  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Left Ventricular ◽  
Atrial Appendage ◽  
Left Ventricular Ejection ◽  
Nonvalvular Atrial Fibrillation ◽  
Eccentric Hypertrophy ◽  
Cardiac Geometry

Abstract Background Nonvalvular atrial fibrillation (AF) is the most common sustained cardiac dysrhythmia and the most frequent cause of cardio-embolic stroke. It is well known that left atrial appendage thrombi (LAAT) are the source of most embolic strokes in patients with AF, and can be easily identified by transesophageal echocardiography (TEE). Purpose To determine additional LAAT predictors not included in the CHA2DS2-VASc score in patients with nonvalvular AF. Methods Retrospective study enrolled 636 patients with nonvalvular AF (400 males) aged 24–84 years (mean age 57.8±9.1), admitted to our Research Center in 2014–2017 for catheter ablation or electrical cardioversion. All patients had scheduled transthoracic echocardiography (TTE), as well as TEE performed to exclude LAAT. Four forms of cardiac geometry were revealed with the help of TTE according to Recommendations of ASE and EACI: normal geometry, concentric remodeling, eccentric hypertrophy and concentric hypertrophy. Results According to TEE results, LAAT (6.6%) was detected in 42 patients from 636. Patients with LAAT more often had persistent and permanent AF (assigned as “AF stability”), had bigger sizes and volumes of left and right cardiac chambers, lower left ventricular ejection fraction, more expressed LV hypertrophy and lower blood flow velocity in the LA appendage compared to patients without LAAT. Remodeling types also varied: less LAAT patients had normal cardiac geometry and more LAAT patients had LV eccentric hypertrophy. To analyze factors associated with AF, we used a multivariable logistic regression model, involving the potential independent, clinically relevant variables and echocardiographic parameters. Logistic regression analysis identified the latter three as independent predictors for LAAT (Table 1). According to ROC-analysis the quality of the received model was assessed as good: AUC=0.763 (p<0.01), sensitivity – 75.8%, specificity – 72.2%. Table 1 Predictors B Wald statistics χ2 P OR 95% CI AF stability 0.913 4.143 0.042 2.491 1.034–6.000 LA diameter, mm 0.149 8.684 0.003 1.160 1.051–1.281 Eccentric hypertrophy 1.440 7.411 0.006 4.222 1.497–11.908 Constant −10.613 24.088 0.000 Conclusion From risk factors, not included in the CHA2DS2-VASc score, in addition to such predictable values as AF stability and left atrial diameter, such predictor as eccentric left ventricular hypertrophy was revealed, which in our study was associated with more than a 4-fold increase in the risk of LAAT.

scholarly journals Predictors of spontaneous echo contrast and left atrial appendage thrombosis in nonvalvular atrial fibrillation

2020 ◽  
Vol 25 (7) ◽  
pp. 3765
Author(s):  
N. Yu. Khorkova ◽  
T. P. Gizatulina ◽  
A. V. Belokurova ◽  
E. A. Gorbatenko
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Left Ventricular ◽  
Atrial Appendage ◽  
Nonvalvular Atrial Fibrillation ◽  
Spontaneous Echo Contrast ◽  
Obese Class ◽  
Group 2 ◽  
Group 1

Aim. To identify predictors of spontaneous echo contrast (SEC) and/or left atrial appendage (LAA) thrombosis in patients with nonvalvular atrial fibrillation (AF) who are referred for elective cardioversion or catheter ablation (CA).Material and methods. A retrospective analysis of data from 638 patients with nonvalvular AF who were hospitalized from 2014 to 2017 for cardioversion or CA was performed. All patients underwent diagnostic tests, including transthoracic and transesophageal echocardiography (TEE).Results. According to the TEE results, two groups of patients were formed: group 1 — 95 patients (14,9%) with signs of SEC and/or thrombosis in LAA; group 2 — 543 patients (85,1%) without SEC or thrombosis in LAA. Patients with the phenomenon of SEC and/or LAA thrombosis were older, had a higher risk on the CHA2DS2-VASc score. These patients were more likely to have coronary heart disease (CAD), hypertension, stage IIA chronic heart failure, obese class >II, persistent or permanent AF Patients in both groups did not differ in anticoagulant therapy. Patients in group 1 had a larger size of the left and right atria, right ventricle, left ventricular (LV) end-systolic and end-diastolic diameters, higher LV mass index, lower values of LV ejection fraction and blood flow velocity in LAA. Logistic regression revealed following independent predictors of SEC and/or LAA thrombosis: CAD (odds ratio (OR) 2,289; 95% confidence interval (CI) 1,313-3,990; p=0,003), persistent or permanent AF (OR 2,071; 95% CI 1,222-3,510; p=0,007), LA diameter >43 mm (OR 3,569; 95% CI 2,0822-6,117; p<0,001), concentric or eccentric LV hypertrophy (OR 2,230; 95% CI 1,302-3,819; p=0,003).Conclusion. As the result, all patients referring for CA or cardioversion, regardless of the CHA2DS2-VASc score, should underwent LAA. According to this study, the presence of CAD, persistent or permanent AF, LA diameter >43 mm, concentric or eccentric LV hypertrophy are independent predictors of SEC and/or LAA thrombosis.

scholarly journals Transesophageal echocardiography for cardiovascular risk estimation in patients with sepsis and new-onset atrial fibrillation: a multicenter prospective pilot study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Vincent Labbé ◽  
Stephane Ederhy ◽  
Nathanael Lapidus ◽  
Jérémie Joffre ◽  
Keyvan Razazi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Cardiovascular Events ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction ◽  
Arterial Thromboembolic Events ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Background Echocardiographic parameters have been poorly investigated for estimating cardiovascular risk in patients with sepsis and new-onset atrial fibrillation. We aim to assess the prevalence of transesophageal echocardiographic abnormalities and their relationship with cardiovascular events in mechanically ventilated patients with sepsis and new-onset atrial fibrillation. Methods In this prospective multicenter pilot study, left atrial/left atrial appendage (LA/LAA) dysfunction, severe aortic atheroma, and left ventricular systolic dysfunction were assessed using an initial transesophageal echocardiographic study, which was repeated after 48–72 h to detect LA/LAA thrombus formation. The study outcome was a composite of cardiovascular events at day 28, including arterial thromboembolic events (ischemic stroke, non-cerebrovascular arterial thromboembolism, LA/LAA thrombus), major bleeding, and all-cause death. Results The study population comprised 94 patients (septic shock 63%; 35% women; median age 69 years). LA/LAA dysfunction, severe aortic atheroma, and left ventricular systolic dysfunction were detected in 17 (19%), 22 (24%), and 27 (29%) patients, respectively. At day 28, the incidence of cardiovascular events was 46% (95% confidence interval [CI]: 35 to 56). Arterial thromboembolic events and major bleeding occurred in 7 (7%) patients (5 ischemic strokes, 1 non-cerebrovascular arterial thromboembolism, 2 left atrial appendage thrombi) and 18 (19%) patients, respectively. At day 28, 27 patients (29%) died. Septic shock (hazard ratio [HR]: 2.36; 95% CI 1.06 to 5.29) and left ventricular systolic dysfunction (HR: 2.06; 95% CI 1.05 to 4.05) were independently associated with cardiovascular events. Conclusions Transesophageal echocardiographic abnormalities are common in mechanically ventilated patients with sepsis and new-onset atrial fibrillation, but only left ventricular systolic dysfunction was associated with cardiovascular events at day 28.

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