The value of diastolic function parameters in the prediction of left atrial appendage thrombus in patients with nonvalvular atrial fibrillation

摘要

Background Left ventricular diastolic impairment and consequently elevated filling pressure may contribute to stasis leading to left atrial appendage thrombus (LAAT) in nonvalvular atrial fibrillation (AF). We investigated whether transthoracic echocardiographic parameters can predict LAAT independent of traditional clinical predictors. Methods We conducted a retrospective cohort study of 297 consecutive nonvalvular AF patients who underwent transthoracic echocardiogram followed by a transesophageal echocardiogram within one year. Multivariate logistic regression analysis models were used to determine factors independently associated with LAAT. Results Nineteen subjects (6.4%) were demonstrated to have LAAT by transesophageal echocardiography. These patients had higher mean CHADS₂ scores [2.6?±?1.2 vs. 1.9?±?1.3, P?=?0.009], higher E:e’ ratios [16.6?±?6.1 vs. 12.0?±?5.4, P?=?0.001], and lower mean e’ velocities [6.5?±?2.1?cm/sec vs. 9.1?±?3.2?cm/sec, P?=?0.001]. Both E:e’ and e’ velocity were associated with LAAT formation independent of the CHADS₂ score, warfarin therapy, left ventricular ejection fraction (LVEF), and left atrial volume index (LAVI) [E:e’ odds-ratio?=?1.14 (95% confidence interval?=?1.03 – 1.3), P?=?0.009; e’ velocity odds-ratio?=?0.68 (95% confidence interval?=?0.5 – 0.9), P?=?0.007]. Similarly, diastolic function parameters were independently associated with spontaneous echo contrast. Conclusion The diastolic function indices E:e’ and e’ velocity are independently associated with LAAT in nonvalvular AF patients and may help identify patients at risk for LAAT.