The effect of left atrial appendage functions on the formation of spontaneous echocardiographic contrast and thrombus: A transesophageal echocardiography study

Sol atriyum apendiks fonksiyon bozukluklarının, sol atriyumda spontan ekokardiyografik kontrast ve trombüs oluşumu ile ilişkisi: Bir transözefageal ekokardiyografi çalışması

Abstract

This prospective study was undertaken to analyze the influence of atrial fibrillation and/or mitral stenosis on left atrial appendage anotomy, function and flows and the effect of these parameters on left atrial spontaneous echocardiographic contrast and thrombus formation. Fourty-three patients with atrial fibrillation and/or mitral stenosis and 10 controls underwent transesophageal echocardiorgaphy, and the effect of atrial fibrillation and mitral stenosis was examined with 2x2 factorial design. Left atrial dimensions were significantly smaller in the controls when compared to other groups, with the largest dimensions observed in patients with atrial fibrillation and mitral stenosis. Left atrial appendix filling and empting velocities were decrased in all groups compared to controls with the lowest values obtained in the group with atrial fibrillation and mitral stenosis. Left atrial appendix maximal area were the greatest in the atrial fibrillation plus mitral stenosis group with the least area obtained in the controls. The other 2 groups had intermediate dimensions. Left atrial ejection fraction dropped in all the groups compared to controls. To analyze the factors influential in the development of spontaneous echocardiographic contrast all the cases were pooled and analyzed. On univariate analysis, embolie history, presence of atrial fibrillation, increased left atrial appendage maximum dimensions, decreased left atrial appendage empting peak flow velocity and ejection fraction was significantly associated with left atrial spontaneous constrast. On multivariate analysis only left atrial appendage empting peak flow velocity was retained as a significant factor. We concluded that examination of left atrium and left atrial appendage gives useful information on thromboembo-lic risk in this patient group.

Özet

Bu çalışma, atriyal fıbrillasyon ve mitral stenozunda sol atriyum apendiksinde meydana gelen anatomik ve fonksiyonel değişiklikleri görmek ve bu değişikliklerin sol atriyumda spontan eko kontrast veya trombus oluşması ile ilişkisini değerlendirmek için düzenlendi. Bu amaçla 43 atriyal fibrillasyon ve/veya mitral darlığı olan hasta ve 10 normal kişi traflfcözefageal ekokardiyografi ile prospektif olarak değerlendirildi ve sol atriyal apendiks fonksiyonları ve akımları incelendi. Bu hastalar ve kontroller atriyal fibrillasyon ve mitral stenozuna göre 2x2 faktöriyel şema içinde incelendiler. Sol atriyum çapları kontrollerde diğer gruplara göre anlamlı olarak küçük bulunurken, mitral stenozu ile beraber atriyal fibrillasyonu olan hasta grubunda diğer gruplara göre anlamlı olarak daha büyüktü (p