Role of Mitral Annular Systolic Velocity in The Evaluation of Left Atrial Appendage Function in Mitral Stenosis.
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Date
2008
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Abstract
Background : Mitral stenosis (MS) is the most common valvular heart disease. Thromboembolism
is one of the most important complications of MS, especially when it is associated with atrial
fibrillation (AF).Patients with sinus rhythm (SR) are also sussceptible to this complication when it
is associated with left atrial appendage (LAA) dysfunction .LAA dysfunction is an independent
predictor of thromboembolism in mitral stenosis.
Objectives: To investigate whether there is a relation between mitral annular velocities obtained by
Doppler tissue imaging (DTI) and LAA function determined by transoesophageal echocardiography
(TEE) and to determine if the annular velocities can predict the presence of the inactive LAA in MS.
Methods: Sixty MS patients were evaluated by transthoracic echocardiography and all patients
underwent transesophageal echocardiography. The annular systolic (S-wave) and diastolic (Emand
Am-waves) velocities were recorded. Inactive LAA was defined as LAA emptying velocity <25
cm/sec. Patients were divided into three groups; group AI (n = 18): sinus rhythm (SR) and LAA
emptying velocity eā25 cm/sec, group AII (n =22): SR and LAA emptying velocity <25cm/sec and
group B (n = 20): atrial fibrillation.
Results: Thrombus was detected in 14 patients and spontaneous echo contrast (SEC) was detected in 48
patients. Both S-wave and peak LAA emptying velocities were decreasing, while SEC frequency and
density were increasing from group A to group B. There was a positive correlation between LAA
emptying vs. S-wave and LAA emptying vs. Am velocities (p < 0.001, r = 0.708 and p< 0.001, r=0.495).
Multivariate regression analysis showed that only S-wave is the independent predictor of inactive LAA
(p = 0.001, odds ratio = 0.133, 95% CI = 0.032ā0.556). In patients with SR, the cutoff value of S-wave was
14 cm/sec for the prediction of the presence of inactive LAA (sensitivity: 92.3%, specificity: 95.3%).
Conclusions: S-wave is an independent predictor of inactive LAA and a useful parameter in
estimating inactive LAA in MS with SR..
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Majumder A A S, Tanveer M S, Reza A Q M, Chowdhury A W, Shahabuddin M. Role of Mitral Annular Systolic Velocity in The Evaluation of Left Atrial Appendage Function in Mitral Stenosis. Cardiovascular Journal. 2008; 1(1): 26-33.