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01.12.2012 | Research | Ausgabe 1/2012 Open Access

Cardiovascular Ultrasound 1/2012

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

Zeitschrift:
Cardiovascular Ultrasound > Ausgabe 1/2012
Autoren:
Koji Ono, Makoto Iwama, Masanori Kawasaki, Ryuhei Tanaka, Takatomo Watanabe, Noriyuki Onishi, Shunichiro Warita, Tai Kojima, Takashi Kato, Yoshiaki Goto, Masazumi Arai, Kazuhiko Nishigaki, Genzou Takemura, Toshiyuki Noda, Sachiro Watanabe, Shinya Minatoguchi
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1476-7120-10-50) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

KO and MI carried out subject recruitment and analyzed data. MK and RT analyzed data and wrote the manuscript. TW, NO, SW, TK, TK, and YG performed ultrasound analysis. MA, KN, GT, TN, SW and SM analyzed data. All authors read and approved the final manuscript.

Abstract

Background

The aim of this study was to define the independent determinants of left atrial appendage (LAA) thrombus among various echocardiographic parameters measured by Velocity Vector Imaging (VVI) in patients with nonvalvular atrial fibrillation (AF) receiving warfarin, particularly in patients with a low CHADS2 score.

Methods

LAA emptying fraction (EF) and LAA peak longitudinal strain were measured by VVI using transesophageal echocardiography in 260 consecutive patients with nonvalvular persistent AF receiving warfarin. The patients were divided into two groups according to the presence (n=43) or absence (n=217) of LAA thrombus. Moreover, the patients within each group were further divided into subgroups according to a CHADS2 score ≤1.

Results

Multivariate logistic regression analysis showed that LAAEF was an independent determinant of LAA thrombus in the subgroup of 140 with a low CHADS2 score. Receiver operating characteristics curve analysis showed that an LAAEF of 21% was the optimal cutoff value for predicting LAA thrombus.

Conclusions

LAA thrombus formation depended on LAA contractility. AF patients with reduced LAA contractile fraction (LAAEF ≤21%) require strong anticoagulant therapy to avoid thromboembolic events regardless of a low CHADS2 score (≤1).
Zusatzmaterial
Authors’ original file for figure 1
12947_2012_447_MOESM1_ESM.pdf
Authors’ original file for figure 2
12947_2012_447_MOESM2_ESM.pdf
Authors’ original file for figure 3
12947_2012_447_MOESM3_ESM.pdf
Literatur
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