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Journals / Türk Kardiyoloji Derneği Arşivi / 2019 / Cilt: 47 - Sayı: 2

Left atrial appendage 2D-strain assessed by transesophageal echocardiography is associated with thromboembolic risk in patients with atrial fibrillation

Atriyal fibrilasyon hastalarında transözofajiyal ekokardiyografi ile değerlendirilen sol atriyal apendiks 2D strain’i tromboembolik risk ile ilişkilidir

Dilek Ural
Ertan Vuruşkan
Ayşen Ağaçdiken Ağır
Erhan Saraçoğlu
Tayfun ŞAHİN
Salih Kılıç
Pages
111–121
Publication Date
2022-11-05
DOI
—
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AI Summary & Key Takeaways

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⚡ TL;DR(Too Long; Didn't Read)

In ROC analysis, cut-off values forglobal, medial, apical, and lateral 2D-strain for the presence ofdense SEC/ thrombus were 6.0% p=0.011), 8.0% (p=0.032),6.0% (p=0.033), and 5.4% (p=0.004), respectively.Conclusion: Global and regional LAA mechanics were significantlyrelated to conventional LAA functional parameters andto the presence of LAA-dense SEC/thrombus in patients withAF and may be useful as complementary data for estimatingfuture thromboembolism.

📌 3 Key Takeaways

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Objective & Hypothesis:Objective: The aim of this study was to determine the relationshipof left atrial appendage (LAA) mechanics assessed using2-dimensional (2D)-strain analysis of the gray scale images obtainedduring transesophageal echocardiography (TEE) to theconventional LAA functional parameters, CHA2DS2-VASc score,and the presence of spontaneous echo contrast (SEC) and/orLAA thrombus in patients with non-valvular atrial fibrillation (AF).Methods: The study included 126 patients with AF and 30 controlswith a sinus rhythm who were referred for TEE.
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Key Findings & Data:The global,medial, lateral and apical LAA longitudinal 2D-strain of all patientsand the CHA2DS2-VASc score of AF patients were evaluated.Results: The global, medial, lateral, and apical LAA longitudinal2D-strain results of AF patients were significantly lowerthan those of the controls and revealed moderate but significantcorrelations with LAA flow velocity and LAA area change.Patients with a CHA2DS2-VASc score of 0 or 1 had the highestLAA 2D-strain values and the results revealed that the LAAemptyingvelocity and LAA lateral and medial 2D-strain valueswere independent correlates of CHA2DS2-VASc score.
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Conclusion & Impact:In ROC analysis, cut-off values forglobal, medial, apical, and lateral 2D-strain for the presence ofdense SEC/ thrombus were 6.0% p=0.011), 8.0% (p=0.032),6.0% (p=0.033), and 5.4% (p=0.004), respectively.Conclusion: Global and regional LAA mechanics were significantlyrelated to conventional LAA functional parameters andto the presence of LAA-dense SEC/thrombus in patients withAF and may be useful as complementary data for estimatingfuture thromboembolism.
🔬Design:Research Article
📍Scope:Comprehensive Sample
⚙️Variables:Domain Parameters

Abstract

Objective: The aim of this study was to determine the relationshipof left atrial appendage (LAA) mechanics assessed using2-dimensional (2D)-strain analysis of the gray scale images obtainedduring transesophageal echocardiography (TEE) to theconventional LAA functional parameters, CHA2DS2-VASc score,and the presence of spontaneous echo contrast (SEC) and/orLAA thrombus in patients with non-valvular atrial fibrillation (AF).Methods: The study included 126 patients with AF and 30 controlswith a sinus rhythm who were referred for TEE. The global,medial, lateral and apical LAA longitudinal 2D-strain of all patientsand the CHA2DS2-VASc score of AF patients were evaluated.Results: The global, medial, lateral, and apical LAA longitudinal2D-strain results of AF patients were significantly lowerthan those of the controls and revealed moderate but significantcorrelations with LAA flow velocity and LAA area change.Patients with a CHA2DS2-VASc score of 0 or 1 had the highestLAA 2D-strain values and the results revealed that the LAAemptyingvelocity and LAA lateral and medial 2D-strain valueswere independent correlates of CHA2DS2-VASc score. SECwas detected in 84 patients, of whom, 42 had dense SEC and27 had thrombus in the LAA. Multivariate analysis indicatedthat LAA emptying velocity, LAA area change, and LAA medial2D-strain were independently associated with the presenceof dense SEC/thrombus. In ROC analysis, cut-off values forglobal, medial, apical, and lateral 2D-strain for the presence ofdense SEC/ thrombus were 6.0% p=0.011), 8.0% (p=0.032),6.0% (p=0.033), and 5.4% (p=0.004), respectively.Conclusion: Global and regional LAA mechanics were significantlyrelated to conventional LAA functional parameters andto the presence of LAA-dense SEC/thrombus in patients withAF and may be useful as complementary data for estimatingfuture thromboembolism.

Özet

Amaç: Bu çalışmada, valvüler olmayan atriyal fibrilasyonlu (AF) hastalarda transözofajiyal ekokardiyografi (TEE) sırasında elde edilen gri skala görüntülerinde 2B-strain analizi ile değerlendirilen sol atriyal apandis (LAA) mekanik işlevlerinin geleneksel LAA fonksiyonel parametreleri, CHA2DS2-VASc skoru ve LAA’da spontan eko kontrastı (SEK) ve/veya trombüs varlığı ile ilişkisinin belirlenmesi amaçlandı. Yöntemler: Çalışmaya, TEE için sevk edilen 126 AF’li hasta ve 30 sinüs ritminde kontrol alındı. Tüm hastalarının global, mediyal, lateral ve apikal LAA longitudinal 2D-strain’i ve AF hastalarının CHA2DS2-VASc skoru değerlendirildi. Bulgular: AF hastalarının global, mediyal, lateral ve apikal LAA longitudinal 2D-strain’i kontrollerden anlamlı olarak düşük ve LAA akım hızları ve LAA alan değişikliğiyle orta derecede fakat anlamlı olarak bağıntılıydı. CHA2DS2-VASc skoru 0-1 olan hastalar en yüksek LAA 2D-strain değerlerine sahipti ve CHA2DS2-VASc skoru LAA lateral, mediyal ve global 2D-strain ile anlamlı olarak korele idi. Hastaların 84’ünde SEK, bu hastaların 45’inde yoğun SEK ve/veya trombüs tespit edildi. Global ve bölgesel LAA 2D-strain değerleri yoğun SEK/ trombüsü olan hastalarda anlamlı olarak düşüktü ama çok değişkenli analizde 2D-strain değerlerinin SEK/trombüs varlığının bağımsız belirleyicileri olmadıkları görüldü. ROC analizinde, yoğun SEK/trombüs varlığı için global, mediyal, apikal ve lateral 2D-strain kestirim değerleri sırasıyla %6.0 (p=0.011), %8.0 (p=0.032), %6.0 (p=0.033) ve %5.4 (p=0.004) idi. Sonuç: Global ve bölgesel LAA mekaniği, geleneksel LAA fonksiyonel parametreleri ve LAA yoğun SEK/trombüs varlığı ile anlamlı derecede ilişkilidir ve gelecekteki tromboembolizmi öngördürmede tamamlayıcı bir teknik olarak faydalı olabilir.

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Cite This Article

Ural, D., Vuruşkan, E., Ağır, A. A., Saraçoğlu, E., ŞAHİN, T., Kılıç, S. (2022). Left atrial appendage 2D-strain assessed by transesophageal echocardiography is associated with thromboembolic risk in patients with atrial fibrillation. Türk Kardiyoloji Derneği Arşivi, Cilt: 47 - Sayı: 2, 111–121. https://ajindex.com/articles/632019

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