Strain and Strain Rate Imaging in Evaluating Left Atrial Appendage Function by Transesophageal Echocardiography

ArticleinEchocardiography 24(8):823-9 · October 2007with74 Reads
DOI: 10.1111/j.1540-8175.2007.00469.x · Source: PubMed
This study was planned to assess whether strain rate (Sr) and strain (S) echocardiography is a useful method for functional assessment of the left atrial appendage (LAA). Fifty-seven consecutive patients underwent a clinically indicated study. LAA late empty velocity (LAAEV) was calculated as a gold standard for left atrial appendage function. Real-time 2-dimensional color Doppler myocardial imaging data were recorded from the LAA at a high frame rate. Analysis was performed for LAA longitudinal strain rate and strain from midsegment of lateral wall of LAA. LAA strain determines regional lengthening expressed as a positive value or shortening expressed as a negative value. Peak systolic values were calculated from the extracted curve. Spearman correlation test results showed a statistically significant positive correlation was between the S, Sr variables and LAAEV (LAAEV vs S; r = 0.886, P < 0.001; LAAEV vs Sr: r = 0.897, P < 0.001, respectively). Strain and strain rate values were also significantly lower in patients with spontaneous echocardiographic contrast when compared with those without (strain; 2.42 +/- 0.98 vs 13.1 +/- 5.9, P < 0.001 and strain rate: 0.97 +/- 0.54 vs 3.34 +/- 1.15, P < 0.001, respectively). In addition, LAA strain and strain rate values were significantly lower in the patients with LAA thrombus (strain; 2.15 +/- 0.96 vs 8.35 +/- 6.9, P < 0.001, strain rate; 0.79 +/- 0.46 vs 2.30 +/- 1.48, P < 0.001, respectively). S and Sr imaging can be considered a robust technique for the assessment of the LAA systolic deformation.
    • "An LAA flow velocity of <20 cm/s and prominent SEC are high-risk factors for cerebral embolism [2] [3]. LAA wall motion velocity (LAAWV), which is an indicator of LAA function and thrombogenesis risk, has been measured by transesophageal tissue Doppler echocardiography (TDE) [4] [5] [6] [7] [8] [9]. However, since this is a semiinvasive method, its application as a screening tool is limited. "
    [Show abstract] [Hide abstract] ABSTRACT: Thromboembolic risk has been examined by semi-invasive transesophageal echocardiography. We assessed the risk of thrombogenesis in patients with persistent atrial fibrillation (AF) noninvasively by using transthoracic tissue Doppler echocardiography (TDE) in relation to a low CHADS2 score. Eighty patients with persistent AF underwent both transthoracic and transesophageal echocardiography. Peak left atrial appendage (LAA), wall motion velocity (WV) during LAA contraction was measured by transthoracic and transesophageal TDE. LAA flow velocity was also determined by transesophageal echocardiography. Transthoracic LAAWV could be measured in 78 of the 80 patients, and the values were closely correlated with transesophageal TDE values (r=0.98) and with transesophageal LAA flow velocity (r=0.82). Transthoracic LAAWV was significantly lower with increasing spontaneous echo contrast (SEC) severity (severe SEC, mild SEC, no SEC: 5.7±2.4, 10.2±3.3, and 14.5±5.5cm/s, respectively). Severe SEC was noted in 31 of 61 patients with a CHADS2 score ≤2, in 19 of 46 patients with a CHADS2 score ≤1 and in 6 of 21 patients with a CHADS2 score=0. For diagnosing severe SEC, a transthoracic LAAWV <10cm/s had a sensitivity of 81% and specificity of 92% in the patients with a CHADS2 score ≤2, a sensitivity of 74% and specificity of 91% in the patients with a CHADS2 score ≤1 and a sensitivity of 44% and specificity of 83% in the patients with a CHADS2 score=0. A transthoracic LAAWV <10cm/s in persistent AF patients with a low CHADS2 score may be a very specific diagnostic tool for evaluating severe SEC, one of the high risk factors for thromboembolism.
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  • [Show abstract] [Hide abstract] ABSTRACT: We assessed left atrial appendage (LAA) function using transthoracic tissue Doppler echocardiography (TDE), and examined the influence of aging on LAA contraction and relaxation. The subjects were 45 consecutive patients with heart disease and 110 healthy individuals. LAA wall motion velocity (LAAWV) at the tip of the LAA was measured using transthoracic echocardiography (TTE) and/or transesophageal echocardiography (TEE). We successfully recorded and measured LAAWV using TTE in 105 (95%) of the 110 healthy subjects. When angle correction was applied for the Doppler beam in TTE, LAAWV during contraction (LAAWVc) measured by TTE closely correlated with that measured by TEE (r = 0.97), and LAAWV during relaxation (LAAWVr) measured by TTE closely correlated with that measured by TEE (r = 0.95). LAAWVc and LAAWVr measured by TTE correlated significantly with the LAA flow velocities during LAA contraction and LAA relaxation measured by TEE (r = 0.64, P < 0.001; r = 0.53, P = 0.001). In healthy subjects, although LAAWVc remained unchanged with aging, LAAWVr significantly declined with aging (r =-0.48, P < 0.001) and had a significant negative correlation with left atrial dimension and a significant positive correlation with transmitral flow and annulus velocity during early diastole. Transthoracic TDE can provide information on LAA function. LAA relaxation may be impaired with aging and may be accompanied by early diastolic left ventricular dysfunction and chronic overload to the left atrium.
    Article · Aug 2010
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