Naoyasu Yoshida1,2, Mitsunori Okamoto3, Hidekazu Hirao3, Kazuyoshi Suenari3, Kiyomi Nanba4, Mio Uchida3, Ryo Yamazato3, Yuichiro Watari3, Yukihiro Fukuda3, Hironori Ueda3. 1. Department of Clinical Laboratory, Hiroshima Prefectural Hospital, Hiroshima, Japan. n_yoshida0210@ybb.ne.jp. 2. Echocardiography Division of Clinical Laboratory, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda, Minami-Ku, Hiroshima, 734-8530, Japan. n_yoshida0210@ybb.ne.jp. 3. Department of Cardiology, Hiroshima Prefectural Hospital, Hiroshima, Japan. 4. Department of Clinical Laboratory, Hiroshima Prefectural Hospital, Hiroshima, Japan.
Abstract
PURPOSE: This study examined the role of left atrial (LA) appendage wall velocity (LAAWV) measurement in addition to LA size for the noninvasive assessment of thrombogenesis in patients with atrial fibrillation (AF) and normal plasma D-dimer levels. METHODS: In 58 non-valvular AF patients, LAAWV and the LA volume index (LAVI) were determined by transthoracic echocardiography. LA appendage flow velocity and severity of spontaneous echo contrast (SEC) were determined by transesophageal echocardiography. RESULTS: LAAWV was strongly correlated with LA appendage flow velocity (r = 0.82), and LAVI was weakly correlated with LA appendage flow velocity (r = -0.37). As SEC severity increased, LAAWV decreased (p < 0.001) and LAVI increased (p < 0.001). Among 52 patients with normal D-dimer levels, LAAWV < 10 cm/s had 71 % sensitivity and 94 % specificity for diagnosing severe SEC. Severe SEC was not found in 18/32 large LAVI patients (>34 mL/m(2)), but 17 of the 18 patients (94 %) had LAAWV < 10 cm/s. Severe SEC was found in 3/20 patients with normal LAVI, but all of them showed LAAWV < 10 cm/s. CONCLUSION: The noninvasive measurement of transthoracic LAAWV in addition to LA volume is clinically relevant for quantitatively assessing thrombogenesis in AF patients with normal D-dimer levels.
PURPOSE: This study examined the role of left atrial (LA) appendage wall velocity (LAAWV) measurement in addition to LA size for the noninvasive assessment of thrombogenesis in patients with atrial fibrillation (AF) and normal plasma D-dimer levels. METHODS: In 58 non-valvular AFpatients, LAAWV and the LA volume index (LAVI) were determined by transthoracic echocardiography. LA appendage flow velocity and severity of spontaneous echo contrast (SEC) were determined by transesophageal echocardiography. RESULTS: LAAWV was strongly correlated with LA appendage flow velocity (r = 0.82), and LAVI was weakly correlated with LA appendage flow velocity (r = -0.37). As SEC severity increased, LAAWV decreased (p < 0.001) and LAVI increased (p < 0.001). Among 52 patients with normal D-dimer levels, LAAWV < 10 cm/s had 71 % sensitivity and 94 % specificity for diagnosing severe SEC. Severe SEC was not found in 18/32 large LAVI patients (>34 mL/m(2)), but 17 of the 18 patients (94 %) had LAAWV < 10 cm/s. Severe SEC was found in 3/20 patients with normal LAVI, but all of them showed LAAWV < 10 cm/s. CONCLUSION: The noninvasive measurement of transthoracic LAAWV in addition to LA volume is clinically relevant for quantitatively assessing thrombogenesis in AFpatients with normal D-dimer levels.