Average e′ velocity on transthoracic echocardiogram is a novel predictor of left atrial appendage sludge or thrombus in patients with atrial fibrillation. Issue 12 (12th October 2018)

• Record Type: Journal Article
• Authors: Garshick, Michael S.; Mulliken, Jennifer; Schoenfeld, Matthew; Riedy, Katherine; Guo, Yu; Zhong, Judy; Dodson, John A.; Saric, Muhamed; Skolnick, Adam H.
• Is Part Of: Echocardiography. Volume 35:Issue 12(2018)
• Page Start: 1939
• Page End: 1946
• Publication Date: 2018-10-12
• Subjects: arrhythmias -- diagnostic Testing -- echocardiography -- embolism -- left atrial appendage thrombus; Echocardiography -- Periodicals; Echocardiography -- Periodicals; 616.1207543
• DOI: 10.1111/echo.14148
• Languages: English
• ISSNs: 0742-2822

Abstract

Abstract : Background: Studies have demonstrated the value of transthoracic echocardiogram (TTE) diastolic parameters in predicting left atrial appendage (LAA) thrombus; however, these studies have been small. We aim to clarify the relationship between TTE diastolic parameters, in particular average e′, and LAA thrombus or sludge. Methods: A case‐control review was conducted of subjects with non‐valvular atrial fibrillation (n = 2263) who had undergone TEE (transesophageal echocardiogram) and had a TTE within 1 year of TEE. Cases of LAA sludge or thrombus were matched to controls by age, sex, left ventricular ejection fraction (LVEF), and anticoagulation status. Results: Forty‐three subjects (mean age 73 ± 12, 65% male, LVEF 47%, 44% on anticoagulation) with LAA sludge or thrombus were identified. Compared to matched controls, average TTE e′ (7.3 ± 2.1 cm/s vs 8.7 ± 2.1 cm/s, P < 0.001) and the E:e′ ratio (15 ± 7 cm/s vs 12 ± 5 cm/s; P = 0.005) were significant predictors of LAA sludge or thrombus. Average TTE e′ value of >11 cm/s had 100% sensitivity for ruling out LAA sludge or thrombus. Conclusion: In individuals with atrial fibrillation, average e′ >11 cm/s on TTE is a promising independent predictor of the absence of LAA sludge or thrombus on TEE.