Author + information
- Michael Seth Garshick,
- Jennifer Mulliken,
- Matthew Schoenfeld,
- Katherine Riedy,
- Yu Guo,
- Judy Zhong,
- John A. Dodson,
- Muhamed Saric and
- Adam Skolnick
Background: In patients with atrial fibrillation, thrombus formation in the left atrial appendage (LAA) is typically diagnosed with transesophageal echocardiogram (TEE). The purpose of our study was to evaluate whether diastolic parameters on transthoracic echocardiogram (TTE) can predict LAA thrombi. We hypothesized that higher lateral e’ velocities may be associated with more vigorous LAA contraction and thus a decreased risk of thrombus formation.
Methods: A case-control review was performed of the echocardiogram database at New York University Medical Center for all subjects with non-valvular atrial fibrillation (n = 2262) who had undergone TEE between 2010 and 2015 and had a TTE within 1 year of TEE. Cases of LAA thrombus were matched to controls in a 1 to 3 fashion by age, gender, ejection fraction (EF) and anticoagulation status. Baseline differences were assessed through stratified linear regression for continuous variables and conditional logistic regression for categorical ones. Conditional logistic regression analysis was used to assess the association between lateral e’ velocity and LAA thrombus.
Results: Thirty-eight subjects (mean age 73 ± 12, 63% male, EF 47%, 50% on anticoagulation) with a LAA thrombus were identified. In cases compared to controls, there was no difference in mean CHA2DS2-VASc or their individual components (3.80 vs. 3.28; p = 0.15 for CHA2DS2-VASc). Compared to matched controls, lateral e’ velocity (8.9 ± 2.4 cm/s vs. 10.2 ± 2.6 cm/s; p < 0.01), medial e’ velocity (5.8 ± 1.7 cm/s vs. 7.3 ± 2.2 cm/s; p < 0.01), E:e’ ratio (13.7 ± 4.5 cm/s vs. 11.8 ± 4.6 cm/s; p = 0.03), and left atrial volume index (43.8 ± 16.2 ml/m2 vs. 35.6 ± 12.6 ml/m2; p = 0.01) were all significant predictors of LAA thrombi. Analysis assessing the association between lateral e’ velocity and LAA thrombus yielded an odds ratio of 0.80 (CI 0.69, 0.93; p < 0.01). A lateral e’ value of less than 11 cm/s resulted in a 2.6 fold (CI 1.09, 6.14; p = 0.03) increased odds of a LAA thrombus. No patient with a lateral e’ velocity over 13 cm/s had a LAA thrombus.
Conclusions: In individuals with atrial fibrillation undergoing TEE to rule out a LAA thrombus, reduced e’ velocity on TTE represents a strong independent predictor of LAA thrombi.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Novel Echocardiographic Methods for Assessing Cardiac Function
Abstract Category: 28. Non Invasive Imaging: Echo
Presentation Number: 1120-231
- 2017 American College of Cardiology Foundation