Document Detail

Predictors of left atrial appendage clot: a transesophageal echocardiographic study of left atrial appendage function in patients with severe mitral stenosis.
MedLine Citation:
PMID:  15751518     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The purpose of this study was to prospectively evaluate a large group of consecutive, non-anticoagulated patients with severe rheumatic mitral stenosis and to analyze the left atrial appendage function in relation to left atrial appendage clot and spontaneous echo contrast formation. METHODS AND RESULTS: We prospectively studied left atrial appendage function in 200 consecutive patients with severe mitral stenosis who underwent transesophageal echocardiography and correlated it with spontaneous echo contrast and left atrial appendage clot. The mean age was 30.2 +/- 9.4 years. Fifty-five (27.5%) patients were in atrial fibrillation. Left atrial appendage clot was present in 50 (25%) patients and 113 (56.5%) had spontaneous echo contrast. The older age, increased duration of symptoms, atrial fibrillation, spontaneous echo contrast, larger left atrium, depressed left atrial appendage function and type II and III left atrial appendage flow patterns correlated significantly (p<0.05) with the left atrial appendage clot. Left atrial appendage ejection fraction was significantly less in patients with clot (21.8 +/- 12.8% v. 39.1 +/- 13.2%, p<0.0001) and in those with spontaneous echo contrast (30.3 +/- 16.2 % v. 40.3 +/- 11.8%, p<0.001). Left atrial appendage filling (18.0 +/- 11.7 v. 27.6 +/- 11.8 cm/s, p <0.0001) and emptying velocities (15.4 +/- 7.0 v. 21.5 +/- 9.6 cm/s, p<0.001) and filling (1.4 +/- 1.0 v. 2.5 +/- 1.4 cm, p<0.0001) and emptying (1.5 +/- 1.2 v. 2.1 +/- 1.2 cm, p <0.05) velocity time integrals were also significantly lower in patients with clot as compared to those without clot. On multivariate regression analysis, atrial fibrillation (odds ratio 6.68, 95% CI 1.85-24.19, p=0.003) and left atrial appendage ejection fraction (odds ratio 1.06, 95% CI 1.00 - 1.11, p=0.04) were the only two independent predictors of clot formation. Incidence of clot was 62.59% in patients with left atrial appendage ejection fraction < or = 25% as compared to 10.4% in those having left atrial appendage ejection fraction >25%. Similarly patients with spontaneous echo contrasthadlower filling (21.7 +/- 11.5 v. 29.4 +/- 12.7 cm/s, p<0.0001) and emptying (17.0 +/- 8.1 v. 23.9 +/- 10.9 cm/s, p<0.0001) velocities, as well as filling (1.9 +/- 1.3 v. 2.7 +/- 1.3 cm, p<0.01) and emptying (1.7 +/- 1.0 v. 2.3 +/- 1.4 cm, p<0.01) velocity time integrals as compared to patients without spontaneous echo contrast. In a subgroup of the patients with normal sinus rhythm, the left atrial appendage ejection fraction was significantly less in patients with clot compared to those without clot (31.2 +/- 13.2 v. 41.3 +/- 11.5 %, p<0.01). CONCLUSIONS: In the patients with severe mitral stenosis, besides atrial fibrillation, a subgroup of patients in normal sinus rhythm with depressed left atrial appendage function (left atrial appendage ejection fraction < or = 25%) had a higher risk of clot formation in left atrial appendage and these patients should be routinely anticoagulated for prevention of clot formation.
Kewal C Goswami; Rakesh Yadav; Vinay K Bahl
Related Documents :
22143278 - Myotonic dystrophies and the heart.
9196408 - Haemostatic and haemodynamic abnormalities associated with left atrial thrombosis in no...
2888868 - Selective ganglionic blockade of vagal inputs to sinoatrial and/or atrioventricular reg...
9584308 - Atrial dissociation after atrial compartment operation for chronic atrial fibrillation ...
7051908 - Emergency diagnosis, resuscitation, and treatment of acute penetrating cardiac trauma.
16846438 - The value of upsloping st depression in diagnosing myocardial ischemia.
Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  Indian heart journal     Volume:  56     ISSN:  0019-4832     ISO Abbreviation:  Indian Heart J     Publication Date:    2004 Nov-Dec
Date Detail:
Created Date:  2005-03-08     Completed Date:  2005-03-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0374675     Medline TA:  Indian Heart J     Country:  India    
Other Details:
Languages:  eng     Pagination:  628-35     Citation Subset:  IM    
Department of Cardiology, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Atrial Appendage / physiopathology,  ultrasonography*
Atrial Function, Left / physiology*
Blood Flow Velocity
Coronary Thrombosis / complications,  physiopathology,  ultrasonography*
Echocardiography, Transesophageal*
Mitral Valve Stenosis / complications,  physiopathology,  ultrasonography*
Predictive Value of Tests
Prospective Studies
Pulsatile Flow
Severity of Illness Index

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Robotically enhanced coronary artery bypass surgery.
Next Document:  QT dispersion and early arrhythmic risk in acute myocardial infarction.