Left Atrial Appendage Function Assessment by Tissue Doppler Transesophageal Echocardiography in Acute Ischemic Stroke Patients

Authors

  • Tamer Abdel Mawla Department of Critical Care, Faculty of Medicine, Fayoum University, Faiyum, Egypt https://orcid.org/0000-0001-9352-1515
  • Osama Momtaz Department of Critical Care, Faculty of Medicine, Fayoum University, Faiyum, Egypt
  • Mohamed Abdel Gayed Department of Critical Care, Faculty of Medicine, Fayoum University, Faiyum, Egypt
  • Gomaa Abdelrazek Department of Cardiology, Faculty of Medicine, Fayoum University, Faiyum, Egypt

DOI:

https://doi.org/10.3889/oamjms.2021.5842

Keywords:

Selected, Atrial fibrillation, Embolic stroke, Left atrial appendage, Transesophageal echocardiography

Abstract

Background: Strokes due to Cardioembolic causes are the most severe in ischemic stroke subtypes. LAA flow patterns and function could be assessed accurately by TEE. The study aimed to present the importance of Transesophageal echocardiography in the assessment of LAA function and its relation to cardioembolic stroke. Methods: 120 patients were enrolled in the study and were subdivided into 3 subgroups, each group included 40 patients. Group A; patients had a stroke with normal sinus rhythm, Group B; patients had a stroke with atrial fibrillation, and Group C; normal control subjects. The study participants were evaluated by medical history, physical examination, standard 12-leads electrocardiogram, a transesophageal echocardiographic detailed evaluation of the LAA, and brain CT and/or MRI for patients with stroke. Results: both stroke patients with AF and sinus rhythm had significantly higher LAA mean orifice diameter and higher LAA length than control patients, significantly lower mean LAA medial wall tissue Doppler upward and downward motion velocities than control patients and that patients with stroke and AF had significantly lower mean LAA pulsed wave emptying and filling velocities than both patients with stroke and sinus rhythm and control patients. Presence of LAA thrombi, spontaneous echo contrast, and stroke recurrence were higher in stroked AF patients than stroke patients with sinus rhythm. Conclusion: increased LAA orifice diameter, LAA length, and reduced filling and emptying velocities and upward and downward motion velocities of the medial wall of LAA as detected by TEE are associated with stroke and cardio embolization.

 

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References

Krishnamurthi RV, Feigin VL, Forouzanfar MH, Mensah GA, Connor M, Bennett DA, et al. Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990-2010: Findings from the global burden of disease study 2010. Lancet Glob Health. 2013;383(9913):218. https://doi.org/10.1016/s0140-6736(13)61953-4 DOI: https://doi.org/10.1016/S0140-6736(13)61953-4

Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, et al. Prevalence of diagnosed atrial fibrillation in adults: National implications for rhythm management and stroke prevention: The anticoagulation and risk factors in atrial fibrillation (ATRIA) Study. JAMA. 2001;285(18):2370-5. https://doi.org/10.1001/jama.285.18.2370 PMid:11343485 DOI: https://doi.org/10.1001/jama.285.18.2370

de Bruijn SF, Agema WR, Lammers GJ, van der Wall EE, Wolterbeek R, Holman ER, et al. Transesophageal echocardiography is superior to transthoracic echocardiography in management of patients of any age with transient ischemic attack or stroke. Stroke. 2006;37(10):2531-4. https://doi.org/10.1161/01.str.0000241064.46659.69 PMid:16946152 DOI: https://doi.org/10.1161/01.STR.0000241064.46659.69

Vanassche T, Lauw MN, Eikelboom JW, Healey JS, Hart RG, Alings M, et al. Risk of ischaemic stroke according to pattern of atrial fibrillation: Analysis of 6563 aspirin-treated patients in ACTIVE-A and AVERROES. Eur Heart J. 2015;36(5):281-7a. https://doi.org/10.1093/eurheartj/ehu307 PMid:25187524 DOI: https://doi.org/10.1093/eurheartj/ehu307

Chao TF, Liu CJ, Chen SJ, Wang KL, Lin YJ, Chang SL, et al. Atrial fibrillation and the risk of ischemic stroke: Does it still matter in patients with a CHA2DS2-VASc score of 0 or 1? Stroke. 2012;43(10):2551-5. https://doi.org/10.1161/strokeaha.112.667865 PMid:22871677 DOI: https://doi.org/10.1161/STROKEAHA.112.667865

Nucifora G, Faletra FF, Regoli F, Pasotti E, Pedrazzini G, Moccetti T, et al. Evaluation of the left atrial appendage with real-time 3-dimensional transesophageal echocardiography: Implications for catheter-based left atrial appendage closure. Circ Cardiovasc Imaging. 2011;4(5):514-23. https://doi.org/10.1161/circimaging.111.963892 PMid:21737601 DOI: https://doi.org/10.1161/CIRCIMAGING.111.963892

Sallach JA, Puwanant S, Drinko JK, Jaffer S, Donal E, Thambidorai SK, et al. Comprehensive left atrial appendage optimization of thrombus using surface echocardiography: The CLOTS multicenter pilot trial. J Am Soc Echocardiogr. 2009;22(10):1165-72. https://doi.org/10.1016/j.echo.2009.05.028 PMid:19647401 DOI: https://doi.org/10.1016/j.echo.2009.05.028

Ono K, Iwama M, Kawasaki M, Tanaka R, Watanabe T, Onishi N, et al. Motion of left atrial appendage as a determinant of thrombus formation in patients with a low CHADS2 score receiving warfarin for persistent nonvalvular atrial fibrillation. Cardiovasc Ultrasound. 2012;10:50. https://doi.org/10.1186/1476-7120-10-50 PMid:23270370 DOI: https://doi.org/10.1186/1476-7120-10-50

Lee JM, Shim J, Uhm JS, Kim YJ, Lee HJ, Pak HN, et al. Impact of increased orifice size and decreased flow velocity of left atrial appendage on stroke in nonvalvular atrial fibrillation. Am J Cardiol. 2014;113(6):963-9. https://doi.org/10.1016/j.amjcard.2013.11.058 PMid:24462064 DOI: https://doi.org/10.1016/j.amjcard.2013.11.058

Chen Z, Bai W, Li C, Wang H, Tang H, Qin Y, et al. Left atrial appendage parameters assessed by real-time three-dimensional transesophageal echocardiography predict thromboembolic risk in patients with nonvalvular atrial fibrillation. J Ultrasound Med. 2017;36(6):1119-28. https://doi.org/10.7863/ultra.16.05070 PMid:28233335 DOI: https://doi.org/10.7863/ultra.16.05070

Beinart R, Heist K, Newell JB, Holmvang G, Ruskin JN, Mansour M. Left atrial appendage dimensions predict the risk of stroke/TIA in patients with atrial fibrillation. J Cardiovasc Electrophysiol. 2011;22(1):10-5. https://doi.org/10.1111/j.1540-8167.2010.01854.x PMid:20662984 DOI: https://doi.org/10.1111/j.1540-8167.2010.01854.x

Ariyama M, Kato S, Matsumura M, Yoshimoto H, Nakajima Y, Nakano S, et al. Left atrial appendage wall-motion velocity associates with recurrence of nonparoxysmal atrial fibrillation after catheter ablation. Echocardiography. 2014;32(2):272-80. https://doi.org/10.1111/echo.12647 PMid:24919546 DOI: https://doi.org/10.1111/echo.12647

Xu G, Liu X, Wu W, Zhang R, Yin Q. Recurrence after ischemic stroke in Chinese patients: Impact of uncontrolled modifiable risk factors. Cerebrovasc Dis. 2007;23(2-3):117-20. https://doi.org/10.1159/000097047 PMid:17124391 DOI: https://doi.org/10.1159/000097047

Wehrum T, Dragonu L, Strecker C, Schuchardt F, Hennemuth A, Drexl J, et al. Aortic atheroma as a source of stroke-assessment of embolization risk using 3D CMR in stroke patients and controls. J Cardiovasc Magn Reson. 2017;19(1):67. https://doi.org/10.1186/s12968-017-0379-x PMid:28877718 DOI: https://doi.org/10.1186/s12968-017-0379-x

Merkler AE, Chu SY, Lerario MP, Navi BB, Kamel H. Temporal relationship between infective endocarditis and stroke. Neurology. 2015;85(6):512-6. https://doi.org/10.1212/wnl.0000000000001835 PMid:26163428 DOI: https://doi.org/10.1212/WNL.0000000000001835

Sun YP, Homma S. Patent foramen Ovale and stroke. Circ J. 2016;80(8)1665-73. https://doi.org/10.1253/circj.cj-16-0534 PMid:27334127 DOI: https://doi.org/10.1253/circj.CJ-16-0534

Leppert M, Poisson SN, Carrolk JD. Atrial septal defects and cardio embolic strokes. Cardiol Clin. 2016;34(2):225-30. PMid:27150170 DOI: https://doi.org/10.1016/j.ccl.2015.12.004

Yaghi S, Son C, Gray WA, Furie KL, Elkind MS, Kamel H. Left atrial appendage function and stroke risk. Stroke. 2015;46(12):3554-9. https://doi.org/10.1161/strokeaha.115.011273 PMid:26508750 DOI: https://doi.org/10.1161/STROKEAHA.115.011273

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Published

2021-09-07

How to Cite

1.
Abdel Mawla T, Momtaz O, Gayed MA, Abdelrazek G. Left Atrial Appendage Function Assessment by Tissue Doppler Transesophageal Echocardiography in Acute Ischemic Stroke Patients. Open Access Maced J Med Sci [Internet]. 2021 Sep. 7 [cited 2024 Mar. 28];9(B):858-64. Available from: https://oamjms.eu/index.php/mjms/article/view/5842