Assessment of left atrial appendage function with transthoracic tissue Doppler echocardiography

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AimsA transthoracic echocardiographic (TTE) parameter that would stratify atrial fibrillation (AF) risk would be useful. Tissue Doppler imaging can quantify left atrial appendage contraction velocity (LAA AM).Methods and resultsWe studied 141 patients referred for transoesophageal echocardiogram (TEE); 48 were in AF. We obtained TEE and TTE LAA AM velocities from the LAA apex on the parasternal short-axis and apical two-chamber views. Adequate traces were obtained in 118 patients (84%). In these patients, we measured 5382 LAA AM velocity tracings. There was a strong correlation between LAA AM on TEE and TTE parasternal short-axis (r=0.741; P < 0.0001) and apical two-chamber views (r=0.729; P < 0.0001). Patients in AF had lower LAA AM than those with sinus rhythm on parasternal short-axis (12 ± 5 vs. 23 ± 7 cm/s, P < 0.0001) and apical two-chamber (14 ± 5 vs. 23 ± 8 cm/s, P < 0.0001) views. On parasternal short axis, LAA AM velocities were lower in patients with spontaneous echo contrast, 11 ± 4 vs. 22 ± 8 cm/s (P < 0.0001), and in those with thrombus, 8 ± 2 cm/s (P < 0.0001). On apical two-chamber, LAA AM velocities were also lower with spontaneous echo contrast, 12 ± 4 vs. 22 ± 7 cm/s (P < 0.0001), and with thrombus, 10 ± 4 cm/s (P < 0.0001). In patients with AF and TTE LAA AM ≤11 cm/s, we found that nearly one-third had LAA thrombus. In patients with AF and a history of stroke or transient ischaemic attack (TIA), LAA AM velocities were lower compared with those without history of stroke or TIA in the parasternal short-axis (9 ± 3 vs. 13 ± 5 cm/s, P=0.02) and apical two-chamber views (11 ± 3 vs. 15 ± 6 cm/s, P=0.008).ConclusionAcquiring and quantifying LAA AM contraction velocity is feasible on TTE in a high percentage of patients and correlates with TEE. LAA AM was lower in AF compared with sinus rhythm, with spontaneous echo contrast compared to without spontaneous echo contrast, and in AF patients with a history of stroke or TIA. Those with LAA thrombus had the lowest LAA AM velocities. LAA AM is a novel functional parameter that may prove useful for risk stratification of AF.

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