Document Type : Original Article
Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, IR Iran.
Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran.
Background: The left atrial appendage (LAA) spontaneous echo contrast (SEC) is a surrogate marker of thrombotic state in atrial fibrillation (AF). We investigated the correlation between LA speckle-tracking parameters and the LAA SEC or thrombosis.
Methods: This cross-sectional study evaluated 70 AF ablation candidates, irrespective of their rhythm. Complete 2D transthoracic and transesophageal echocardiographic examinations and LA speckle-tracking analyses were performed. Based on the presence of thrombosis and the severity of SEC in the LAA, the patients were divided into 3 groups.
Results: Seventy patients (mean age=54±13.6 y; 37 men) were evaluated. Sinus rhythm was reported in 41 patients and oral anticoagulant consumption in 51. The mean CHA2DS2-VASc score was 1.8±1.4, and the mean LVEF was 51.1±7.4%. The LASr in the 2- and 4-chamber views was lower in subjects with AF rhythm (P<0.0001). Patients with LAA thrombosis and moderate-to-severe SEC, all in AF rhythm, had lower LAA velocities (P<0.0001), LASr (4-chamber view=5.2±1% vs 9±2.7% vs 20.7±8.2%; P<0.0001), LAScd (P=0.003), and mean strain rates (P<0.0001) than patients with mild or no SEC. The best correlation with the LAA SEC was found for the LASr in the 4-chamber view (r= −0.58, P<0.0001). There were no differences in the time-to-peak velocities and the time delay of the opposite walls.
Conclusions: Patients in AF rhythm had remarkably lower LA strain values than those in sinus rhythm. Significantly lower LA emptying velocities and segmental and global speckle-tracking parameters were observed in patients with moderate-to-severe SEC or LAA thrombosis, and the best correlation was shown with the LASr. (Iranian Heart Journal 2021; 22(2): 83-95)