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ASSESSMENT OF LEFT ATRIAL APPENDAGE WALL MOTION USING SPECKLE TRACKING TRANSESOPHAGEAL ECHOCARDIOGRAPHY IS USEFUL TO PREDICT THROMBUS FORMATION IN CHRONIC ATRIAL FIBRILLATION WITH WARFARIN THERAPY
E676 JACC March 27, 2012 Volume 59, Issue 13
Arrhythmias ASSESSMENT OF LEFT ATRIAL APPENDAGE WALL MOTION USING SPECKLE TRACKING TRANSESOPHAGEAL ECHOCARDIOGRAPHY IS USEFUL TO PREDICT THROMBUS FORMATION IN CHRONIC ATRIAL FIBRILLATION WITH WARFARIN THERAPY ACC Moderated Poster Contributions McCormick Place South, Hall A Monday, March 26, 2012, 11:00 a.m.-Noon
Session Title: Arrhythmias: AF/SVT: Outcomes in Patients with Atrial Fibrillation: Beyond CHADS2 Abstract Category: 16. Arrhythmias: AF/SVT Presentation Number: 1236-174 Authors: Makoto Iwama, Ryuhei Tanaka, Shingo Minatoguchi, Shintaro Abe, Reiko Matsuoka, Yoshiaki Goto, Tomoko Fujii, Tai Kojima, Takeshi Hirose, Koji Ono, Shintaro Tanihata, Mami Iida, Toshiyuki Noda, Sachiro Watanabe, Takatomo Watanabe, Masanori Kawasaki, Shinya Minatoguchi, Gifu Prefectural General Medical Center, Gifu, Japan, Gifu University Graduate School of Medicine, Gifu, Japan Background: Left atrial appendage (LAA) thrombus is a high risk factor of thromboembolism in atrial fibrillation (AF). Spontaneous echo contrast (SEC) and LAA flow velocity are predictors of thrombus and CHADS2 is used as a risk stratification. However, LAA contractility which may be evaluated by LAA emptying function (EF), peak strain and radial velocity (RV) of LAA wall motion could contribute to blood stasis and be an important determinant of thrombus formation in chronic AF. Methods: We examined 160 consecutive patients with chronic AF receiving warfarin, who were grouped according to the presence of thrombus; AF with thrombus (n=27,age 69±10) and AF without thrombus (n=133, age 67±11). LAAEF, peak longitudinal strain and peak RV of LAA wall during systole and diastole were measured by 2-D speckle tracking transesophageal echocardiography. LA dimension, LAA max. and min. volume, SEC score and LAA flow velocity were also measured. Results: Sixty three % of patients with thrombus and 65 % without thrombus met the target PT-INR. AF with thrombus had more increased CHADS2 and SEC score and reduced LAA flow velocity, LAAEF, peak strain and RV (Table). On multivariate analysis, LAAEF and peak strain of LAA wall were independent determinants of LAA thrombus. Conclusion: LAAEF and peak strain of LAA wall were more useful predictors of thrombus in chronic AF than LAA flow velocity, SEC and CHADS2 score. Chronic AF patients with reduced LAA contractility should be strictly treated with warfarin to avoid thromboembolism.
Arrhythmias ASSESSMENT OF LEFT ATRIAL APPENDAGE WALL MOTION USING SPECKLE TRACKING TRANSESOPHAGEAL ECHOCARDIOGRAPHY IS USEFUL TO PREDICT THROMBUS FORMATION IN CHRONIC ATRIAL FIBRILLATION WITH WARFARIN THERAPY ACC Moderated Poster Contributions McCormick Place South, Hall A Monday, March 26, 2012, 11:00 a.m.-Noon
Session Title: Arrhythmias: AF/SVT: Outcomes in Patients with Atrial Fibrillation: Beyond CHADS2 Abstract Category: 16. Arrhythmias: AF/SVT Presentation Number: 1236-174 Authors: Makoto Iwama, Ryuhei Tanaka, Shingo Minatoguchi, Shintaro Abe, Reiko Matsuoka, Yoshiaki Goto, Tomoko Fujii, Tai Kojima, Takeshi Hirose, Koji Ono, Shintaro Tanihata, Mami Iida, Toshiyuki Noda, Sachiro Watanabe, Takatomo Watanabe, Masanori Kawasaki, Shinya Minatoguchi, Gifu Prefectural General Medical Center, Gifu, Japan, Gifu University Graduate School of Medicine, Gifu, Japan Background: Left atrial appendage (LAA) thrombus is a high risk factor of thromboembolism in atrial fibrillation (AF). Spontaneous echo contrast (SEC) and LAA flow velocity are predictors of thrombus and CHADS2 is used as a risk stratification. However, LAA contractility which may be evaluated by LAA emptying function (EF), peak strain and radial velocity (RV) of LAA wall motion could contribute to blood stasis and be an important determinant of thrombus formation in chronic AF. Methods: We examined 160 consecutive patients with chronic AF receiving warfarin, who were grouped according to the presence of thrombus; AF with thrombus (n=27,age 69±10) and AF without thrombus (n=133, age 67±11). LAAEF, peak longitudinal strain and peak RV of LAA wall during systole and diastole were measured by 2-D speckle tracking transesophageal echocardiography. LA dimension, LAA max. and min. volume, SEC score and LAA flow velocity were also measured. Results: Sixty three % of patients with thrombus and 65 % without thrombus met the target PT-INR. AF with thrombus had more increased CHADS2 and SEC score and reduced LAA flow velocity, LAAEF, peak strain and RV (Table). On multivariate analysis, LAAEF and peak strain of LAA wall were independent determinants of LAA thrombus. Conclusion: LAAEF and peak strain of LAA wall were more useful predictors of thrombus in chronic AF than LAA flow velocity, SEC and CHADS2 score. Chronic AF patients with reduced LAA contractility should be strictly treated with warfarin to avoid thromboembolism.