Left ventricular lateral annulus and left atrial free-wall velocity time integral indicate thromboembolism in patients with rheumatic atrial fibrillation

Mark C. Arokiaraj, Cristina D Pislaru, Shanmugam Vellayappan, Sitalakshmi Subramanian, Kiron Varghese, Chandrakanth B. Patil, Gurappa G. Shetty, Cherian George, Vishal Gupta, Shamanna S. Iyengar

Research output: Contribution to journalArticle

Abstract

Background: Low wall motion and stasis increase the likelihood of clot formation. We hypothesized that tissue Doppler indices of left atrial (LA) motion are reduced in the presence of LA thrombi and may be predictive for clot formation in patients with atrial fibrillation (AF). Methods: We did an observational study for 3 years in 118 patients with rheumatic mitral valve disease in chronic AF who had not received anticoagulation, with (Group 1, n = 36) and without (Group 2, n = 82) thromboembolism. Pulsed tissue Doppler systolic velocities and velocity time integrals (VTIs) were measured in all four chambers. A mean LA VTI was calculated. LA strain during ventricular systole was calculated using VTI and distance between two LA locations. Results: Logistic regression analysis showed that, after adjusting for age, gender, diabetes, hypertension, LA size, and left ventricular (LV) ejection fraction, mean LA VTI [Odds ratio (OR) 0.69, 95%CI (0.56-0.86, P = 0.03)] and lateral mitral annulus VTI [OR 0.15 (0.04-0.56, P = 0.03)] were associated with clot formation. The addition of these two parameters to the conventional risk factors increased the ability to predict thromboembolism (Nagelkerke R2= 0.32-0.50, P = 0.01; area under the curve 0.83 by receiver operating characteristic analysis, P = 0.01). LA strain also had potential to indicate clot formation (0.9 ± 13.8 vs. -8.2 ± 15.1%, group 1 vs. 2, respectively, P = 0.01). Conclusion: Patients with chronic AF and thromboembolism have reduced LA and LV motion independently of LA size and LV ejection fraction. Tissue Doppler parameters may have potential to predict clot formation in these patients.

Original languageEnglish (US)
Pages (from-to)1038-1048
Number of pages11
JournalEchocardiography
Volume27
Issue number9
DOIs
StatePublished - Oct 2010

Fingerprint

Thromboembolism
Atrial Fibrillation
Stroke Volume
Odds Ratio
Systole
Mitral Valve
ROC Curve
Area Under Curve
Observational Studies
Thrombosis
Chronic Disease
Logistic Models
Regression Analysis
Hypertension

Keywords

  • atrial fibrillation
  • echocardiography
  • stroke
  • thromboembolism
  • tissue Doppler imaging

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Left ventricular lateral annulus and left atrial free-wall velocity time integral indicate thromboembolism in patients with rheumatic atrial fibrillation. / Arokiaraj, Mark C.; Pislaru, Cristina D; Vellayappan, Shanmugam; Subramanian, Sitalakshmi; Varghese, Kiron; Patil, Chandrakanth B.; Shetty, Gurappa G.; George, Cherian; Gupta, Vishal; Iyengar, Shamanna S.

In: Echocardiography, Vol. 27, No. 9, 10.2010, p. 1038-1048.

Research output: Contribution to journalArticle

Arokiaraj, MC, Pislaru, CD, Vellayappan, S, Subramanian, S, Varghese, K, Patil, CB, Shetty, GG, George, C, Gupta, V & Iyengar, SS 2010, 'Left ventricular lateral annulus and left atrial free-wall velocity time integral indicate thromboembolism in patients with rheumatic atrial fibrillation', Echocardiography, vol. 27, no. 9, pp. 1038-1048. https://doi.org/10.1111/j.1540-8175.2010.01198.x
Arokiaraj, Mark C. ; Pislaru, Cristina D ; Vellayappan, Shanmugam ; Subramanian, Sitalakshmi ; Varghese, Kiron ; Patil, Chandrakanth B. ; Shetty, Gurappa G. ; George, Cherian ; Gupta, Vishal ; Iyengar, Shamanna S. / Left ventricular lateral annulus and left atrial free-wall velocity time integral indicate thromboembolism in patients with rheumatic atrial fibrillation. In: Echocardiography. 2010 ; Vol. 27, No. 9. pp. 1038-1048.
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abstract = "Background: Low wall motion and stasis increase the likelihood of clot formation. We hypothesized that tissue Doppler indices of left atrial (LA) motion are reduced in the presence of LA thrombi and may be predictive for clot formation in patients with atrial fibrillation (AF). Methods: We did an observational study for 3 years in 118 patients with rheumatic mitral valve disease in chronic AF who had not received anticoagulation, with (Group 1, n = 36) and without (Group 2, n = 82) thromboembolism. Pulsed tissue Doppler systolic velocities and velocity time integrals (VTIs) were measured in all four chambers. A mean LA VTI was calculated. LA strain during ventricular systole was calculated using VTI and distance between two LA locations. Results: Logistic regression analysis showed that, after adjusting for age, gender, diabetes, hypertension, LA size, and left ventricular (LV) ejection fraction, mean LA VTI [Odds ratio (OR) 0.69, 95{\%}CI (0.56-0.86, P = 0.03)] and lateral mitral annulus VTI [OR 0.15 (0.04-0.56, P = 0.03)] were associated with clot formation. The addition of these two parameters to the conventional risk factors increased the ability to predict thromboembolism (Nagelkerke R2= 0.32-0.50, P = 0.01; area under the curve 0.83 by receiver operating characteristic analysis, P = 0.01). LA strain also had potential to indicate clot formation (0.9 ± 13.8 vs. -8.2 ± 15.1{\%}, group 1 vs. 2, respectively, P = 0.01). Conclusion: Patients with chronic AF and thromboembolism have reduced LA and LV motion independently of LA size and LV ejection fraction. Tissue Doppler parameters may have potential to predict clot formation in these patients.",
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T1 - Left ventricular lateral annulus and left atrial free-wall velocity time integral indicate thromboembolism in patients with rheumatic atrial fibrillation

AU - Arokiaraj, Mark C.

AU - Pislaru, Cristina D

AU - Vellayappan, Shanmugam

AU - Subramanian, Sitalakshmi

AU - Varghese, Kiron

AU - Patil, Chandrakanth B.

AU - Shetty, Gurappa G.

AU - George, Cherian

AU - Gupta, Vishal

AU - Iyengar, Shamanna S.

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N2 - Background: Low wall motion and stasis increase the likelihood of clot formation. We hypothesized that tissue Doppler indices of left atrial (LA) motion are reduced in the presence of LA thrombi and may be predictive for clot formation in patients with atrial fibrillation (AF). Methods: We did an observational study for 3 years in 118 patients with rheumatic mitral valve disease in chronic AF who had not received anticoagulation, with (Group 1, n = 36) and without (Group 2, n = 82) thromboembolism. Pulsed tissue Doppler systolic velocities and velocity time integrals (VTIs) were measured in all four chambers. A mean LA VTI was calculated. LA strain during ventricular systole was calculated using VTI and distance between two LA locations. Results: Logistic regression analysis showed that, after adjusting for age, gender, diabetes, hypertension, LA size, and left ventricular (LV) ejection fraction, mean LA VTI [Odds ratio (OR) 0.69, 95%CI (0.56-0.86, P = 0.03)] and lateral mitral annulus VTI [OR 0.15 (0.04-0.56, P = 0.03)] were associated with clot formation. The addition of these two parameters to the conventional risk factors increased the ability to predict thromboembolism (Nagelkerke R2= 0.32-0.50, P = 0.01; area under the curve 0.83 by receiver operating characteristic analysis, P = 0.01). LA strain also had potential to indicate clot formation (0.9 ± 13.8 vs. -8.2 ± 15.1%, group 1 vs. 2, respectively, P = 0.01). Conclusion: Patients with chronic AF and thromboembolism have reduced LA and LV motion independently of LA size and LV ejection fraction. Tissue Doppler parameters may have potential to predict clot formation in these patients.

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KW - atrial fibrillation

KW - echocardiography

KW - stroke

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KW - tissue Doppler imaging

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