Left atrial appendage mechanical dispersion provides incremental value for thromboembolic risk stratification over CHA2DS2-VASc Score in nonvalvular atrial fibrillation. 2020

Yankai Mao, and Mingming Ma, and Yuan Yang, and Chan Yu, and Yunhe Wang, and Ruhong Jiang, and Chenyang Jiang
Department of Diagnostic Ultrasound & Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.

Left atrial appendage (LAA) dysfunction is associated with increased risk of thromboembolic events. However, little is known about LAA mechanical dispersion (MD) would provide additional information toward thromboembolism over the CHA2DS2-VASc score. The aim of this study was to determine the association of LAA mechanics as assessed by speckle-tracking imaging with thromboembolic events in patients with nonvalvular atrial fbrillation (AF). A total of 116 consecutive patients with AF referred for transesophageal echocardiography (TEE) were prospectively enrolled. Of these, 17(14.7%) patients had prior embolic events. Using speckle-tracking echocardiography (STE), we measured the LAA strain in each of 24 segments in mid-esophageal TEE views obtained at 0°, 45°, 90° and 135°. LAA MD was defined as the standard deviation (SD) of time to peak positive strain corrected by the R-R interval. Patients with embolism had lower LAA global longitudinal strain (GLS) (8.56 ± 2.62% vs 11.37 ± 5.54%, p = 0.002) and higher LAA MD (16.90 ± 6.67% vs 12.10 ± 3.94%; P = 0.010) than those without embolism. LAA MD >13.1% differentiated patients with embolism from controls, with an area under the curve (AUC) of 0.709(p = 0.004). LAA MD was independently associated with the presence of thromboembolism in multivariate analysis (odds ratio, 1.24; 95% confidence interval, 1.08-1.42; P = 0.002). The model based on CHA2DS2-VASc score for discrimination of patients with embolism was significantly improved by adding LAA MD (P < 0.01). LAA MD obtained from strain echocardiography was significantly associated with a prior history of embolic events and had incremental diagnostic value over CHA2DS2VASc score, suggesting that LAA MD may be useful in refining thromboembolic risk stratification in patients with AF.

UI MeSH Term Description Entries
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001281 Atrial Fibrillation Abnormal cardiac rhythm that is characterized by rapid, uncoordinated firing of electrical impulses in the upper chambers of the heart (HEART ATRIA). In such case, blood cannot be effectively pumped into the lower chambers of the heart (HEART VENTRICLES). It is caused by abnormal impulse generation. Auricular Fibrillation,Familial Atrial Fibrillation,Paroxysmal Atrial Fibrillation,Persistent Atrial Fibrillation,Atrial Fibrillation, Familial,Atrial Fibrillation, Paroxysmal,Atrial Fibrillation, Persistent,Atrial Fibrillations,Atrial Fibrillations, Familial,Atrial Fibrillations, Paroxysmal,Atrial Fibrillations, Persistent,Auricular Fibrillations,Familial Atrial Fibrillations,Fibrillation, Atrial,Fibrillation, Auricular,Fibrillation, Familial Atrial,Fibrillation, Paroxysmal Atrial,Fibrillation, Persistent Atrial,Fibrillations, Atrial,Fibrillations, Auricular,Fibrillations, Familial Atrial,Fibrillations, Paroxysmal Atrial,Fibrillations, Persistent Atrial,Paroxysmal Atrial Fibrillations,Persistent Atrial Fibrillations
D012307 Risk Factors An aspect of personal behavior or lifestyle, environmental exposure, inborn or inherited characteristic, which, based on epidemiological evidence, is known to be associated with a health-related condition considered important to prevent. Health Correlates,Risk Factor Scores,Risk Scores,Social Risk Factors,Population at Risk,Populations at Risk,Correlates, Health,Factor, Risk,Factor, Social Risk,Factors, Social Risk,Risk Factor,Risk Factor Score,Risk Factor, Social,Risk Factors, Social,Risk Score,Score, Risk,Score, Risk Factor,Social Risk Factor
D013923 Thromboembolism Obstruction of a blood vessel (embolism) by a blood clot (THROMBUS) in the blood stream. Thromboembolisms
D017548 Echocardiography, Transesophageal Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues using a transducer placed in the esophagus. Transesophageal Echocardiography
D018570 Risk Assessment The qualitative or quantitative estimation of the likelihood of adverse effects that may result from exposure to specified health hazards or from the absence of beneficial influences. (Last, Dictionary of Epidemiology, 1988) Assessment, Risk,Benefit-Risk Assessment,Risk Analysis,Risk-Benefit Assessment,Health Risk Assessment,Risks and Benefits,Analysis, Risk,Assessment, Benefit-Risk,Assessment, Health Risk,Assessment, Risk-Benefit,Benefit Risk Assessment,Benefit-Risk Assessments,Benefits and Risks,Health Risk Assessments,Risk Analyses,Risk Assessment, Health,Risk Assessments,Risk Benefit Assessment,Risk-Benefit Assessments
D020517 Atrial Appendage Ear-shaped appendage of either atrium of the heart. (Dorland, 28th ed) Auricular Appendage,Heart Atrium Appendage,Atrium Appendage,Appendage, Atrial,Appendage, Atrium,Appendage, Auricular,Appendage, Heart Atrium,Appendages, Atrial,Appendages, Atrium,Appendages, Auricular,Appendages, Heart Atrium,Atrial Appendages,Atrium Appendage, Heart,Atrium Appendages,Auricular Appendages,Heart Atrium Appendages

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