Harutoshi Tamura

Yamagata University, Ямагата, Yamagata, Japan

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Publications (25)143.05 Total impact

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    ABSTRACT: Aims: Previous studies reported that integrated backscatter intravascular ultrasound (IB-IVUS) provides high diagnostic accuracy for tissue characterization of coronary plaques and that pregnancy-associated plasma protein A (PAPP-A) could be a marker of adverse cardiac outcome in patients with cardiovascular disease. We examined whether IB-IVUS and PAPP-A levels could predict the incidence of no-reflow during percutaneous coronary intervention (PCI). Methods and Results: 176 consecutive patients (138 men, mean age 68 ± 11 years) who underwent PCI with IB-IVUS were prospectively enrolled. Combined no-reflow, including transient filter no-reflow by using distal protection devices, was observed in 31 patients. The percentages of coronary lipid volume (%LV) analyzed by IB-IVUS and serum PAPP-A were significantly higher in patients with combined no-reflow than normal-reflow. To predict no-reflow, a receiver operating characteristic (ROC) analysis determined cut-off values of %LV as 62% and serum PAPP-A as 7.71 ng/mL. The multivariate logistic regression analysis showed that %LV (hazard ratio 4.5, 95% confidence interval 1.6 to 13.4, P < 0.01) and PAPP-A (hazard ratio 4.32, 95% confidence interval 1.5 to 12.7, P < 0.01) were independent predictors of combined no-reflow. Conclusions: %LV analyzed by IB-IVUS and serum PAPP-A levels were closely associated with the coronary no-reflow phenomenon. © 2013 Wiley Periodicals, Inc.
    No preview · Article · Jan 2015 · Catheterization and Cardiovascular Interventions
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    ABSTRACT: Background : Left atrial appendage (LAA) dysfunction predisposes patients with atrial fibrillation (AF) to cardioembolic stroke. Two-dimensional (2D) speckle tracking was reported to be useful for evaluating left atrial (LA) regional function, as well as left ventricular function. However, it remains unclear whether 2D speckle tracking is useful for evaluating LAA dysfunction. Therefore, we investigated whether decreased LA strain may predict LAA dysfunction and thrombus formation in patients with acute ischemic stroke. Methods We performed transthoracic and transesophageal echocardiography in 120 patients (83 males, mean age 72 ± 11 years) within 7 days of onset of an acute ischemic stroke. Longitudinal LA strain was evaluated using 2D speckle tracking imaging at each LA segment, and peak systolic strain was calculated by averaging the results for each segment. Results Forty-eight patients had LAA dysfunction as defined by the presence of LAA thrombus and/or severe spontaneous echo contrast. LA peak systolic strain was significantly decreased in patients with LAA dysfunction compared to those without (32.3 ± 13.7% vs. 12.1 ± 7.2%, p < 0.0001). LA peak systolic strain was significantly correlated with LAA emptying flow velocity (r = 0.693, p < 0.0001). The optimum LA peak systolic strain cut off value for predicting LAA dysfunction was 19%. Multivariate logistic regression analysis showed that LA peak systolic strain was an independent predictor of LAA dysfunction (odds ratio 0.059, 95% confidence interval 0.018-0.146; p < 0.0001). Conclusion Decreased LA peak systolic strain was independently associated with LAA dysfunction in patients with acute ischemic stroke.
    Full-text · Article · Dec 2014 · Biochimica et Biophysica Acta - Clinical
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    ABSTRACT: Background: The difference between left atrial (LA) and systemic coagulation activity in paroxysmal atrial fibrillation (PAF) is unclear. Methods and results: We enrolled 100 patients with PAF who underwent AF ablation. Warfarin was stopped 1 day before the procedure. LA volume index and LA emptying fraction were measured by 64-slice multidetector computed tomography. Immediately after transseptal puncture, blood samples were simultaneously collected from the LA and systemic circulation (SC). In addition, to evaluate the effect of warfarin on D-dimer levels we recruited an additional 27 PAF patients on continuous warfarin. Even in patients with low CHADS2 scores (mean 0.59 ± 0.68) and during sinus rhythm, the prevalence of positive LA-D-dimer (≥ 0.5 µg/ml) was greater than that of SC-D-dimer (23% vs. 10%, P<0.01). The LA-D-dimer-positive patients had a larger mean LA volume index and reduced LA emptying fraction than the LA-D-dimer-negative patients. Multiple logistic regression analysis revealed that LA volume index was independently correlated with positive LA-D-dimer (odds ratio 2.245, 95% confidence interval 1.194-4.626, P=0.0112). The prevalence of positive LA-D-dimer was significantly lower in patients taking continuous warfarin, than in those on discontinuous warfarin (3.7% vs. 23%, P=0.025). Conclusions: An enlarged LA volume index was associated with high LA coagulation status in patients with paroxysmal AF. Adequate warfarin control during AF catheter ablation may reduce the prevalence of positive LA-D-dimer.
    Preview · Article · Nov 2014 · Circulation Journal
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    ABSTRACT: Background Thioredoxin-1 (Trx-1) is an abundant 12.5 kDa redox protein expressed in almost all eukaryotic cells that protect against the development of heart failure and kidney dysfunction. Plasma Trx-1 levels are considered as a reliable marker for oxidative stress. However, it remains to be determined whether plasma Trx-1 levels can predict cardiac prognosis in patients with chronic heart failure (CHF). Methods and results We measured plasma Trx-1 levels and urinary β2-microglobulin–creatinine ratio (UBCR), a marker for renal tubular damage, in 156 consecutive patients with CHF and 17 control subjects. The patients were prospectively followed for a median follow-up period of 627 days and 46 cardiac events were observed. The patients with cardiac events had significantly higher plasma Trx-1 levels and UBCR levels than the cardiac event-free patients. Multivariate Cox proportional hazard analysis revealed that an elevated Trx-1 level was independently associated with poor outcome in patients with CHF after adjustment for confounding factors (hazard ratio, 1.74; 95% confidence interval, 1.33–2.29; p < 0.0001). UBCR was increased with higher plasma Trx-1 levels. Kaplan–Meier analysis demonstrated that the highest Trx-1 tertile was associated with the highest risk of cardiac events. Conclusion Plasma Trx-1 level was associated with renal tubular damage and cardiac prognosis, suggesting that it could be a useful marker to identify patients at high risk for comorbid heart failure and renal tubular damage.
    No preview · Article · Nov 2014 · Journal of Cardiology
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    ABSTRACT: A 14-year-old patient was diagnosed with hypertrophic cardiomyopathy associated with Wolff-Parkinson-White syndrome. The two-dimensional speckle tracking strain method showed normal left ventricular local contraction, but the peak systolic longitudinal strain of the right ventricular (RV) anterior wall was earlier than that of the septal wall. As expected, the location of the accessory pathway was at the RV anterior wall. The patient's RV local contraction was normalized by successful radiofrequency application.
    No preview · Article · Jul 2014 · Internal Medicine
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    ABSTRACT: Epicardial adipose tissue (EAT) surrounding the heart may contribute to the development of coronary artery disease (CAD) through its local secretion of adipocytokines. Although the quantity of EAT is associated with obesity and metabolic syndrome, the role of EAT in the development of CAD in non-obese patients remains to be determined. This study included 41 patients with CAD who underwent coronary artery bypass graft surgery and 28 patients without CAD who underwent other cardiac surgery. EAT volume was measured by 64-slice multi-detector computed tomography before the surgery. We obtained pericardial fluid and epicardial and subcutaneous adipose tissue samples at the surgery. We investigated the relationship between EAT volume and adiponectin levels in pericardial fluid and incident CAD in patients with and without obesity (body mass index>25kg/m(2)). There was no significant difference in EAT volume between obese patients with and without CAD (55.5±40.2mL vs. 40.1±19.7mL, p=0.323). However, EAT volume was significantly greater in non-obese patients with CAD compared to those without CAD (35.0±18.8mL vs. 15.7±11.0mL, p<0.001). Adiponectin concentrations in pericardial fluid were significantly lower in non-obese patients with CAD compared to those without CAD (2.7±2.0μg/mL vs. 4.3±3.7μg/mL, p=0.049), whereas the adiponectin levels were decreased in obese patients regardless of the presence of CAD. Non-obese patients with CAD had significantly larger size adipocytes in EAT but not subcutaneous adipose tissue compared to those without CAD. Multiple logistic regression analysis showed that increased EAT volume was independently associated with incident CAD in non-obese patients. Increased EAT may play a crucial role in development of CAD through impairment of adiponectin secretion in non-obese patients.
    Full-text · Article · Nov 2013 · Journal of Cardiology
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    ABSTRACT: Atherosclerotic plaque in aortic arch was shown to be a definite risk factor of cerebral infarction. While the metabolic syndrome (Mets) was reported to be closely related to the cardiovascular disease, it is unclear whether Mets is associated with the development of aortic arch plaque. We investigated the impact of Mets on aortic arch plaque formation. We included into the study consecutive 600 subjects aged 40 - 89 years (male/female = 394/206, 69±11 years) who underwent transesophageal echocardiography in our hospital. We defined arch plaque as the presence of wall thickening of ≥ 3 mm, ulceration or mobile plaque in aortic arch. There were 363 subjects with the history of stroke, including 144 subjects with atherothrombotic stroke. Mets was defined according to American Heart Association Scientific Statements 2009. Waist circumference was defined by the International Diabetes Federation criteria for Asian. Wall thickness of aortic arch was significantly greater in subjects with atherothrombotic stroke than those with other types of stroke (cardioembolic, lacunar, and undetermined etiology) and those without stroke (4.7±2.2 mm, 2.3±1.0 mm, 2.7±1.7 mm, respectively, P < 0.0001). Arch wall thickness was increased with clustering metabolic risk factors (score 0, 2.3±1.5 mm; score 1, 2.8±1.6 mm; score 2, 3.1±1.7 mm; score 3, 3.5±1.8 mm, score 4-5, 4.0±3.2 mm; P < 0.0001). Aortic arch plaque was significantly associated with age, sex, hypertension (systolic blood pressure, pulse pressure), diabetes (fasting plasma glucose, hemoglobin A1c), high-density lipoprotein cholesterol, estimated glomerular filtration rate, fibrinogen, cardio ankle vascular index, and Mets in the univariate analysis. Arch plaque was significantly increased with clustering metabolic risk factors (score 1, odds ratio 2.02; score 2, 2.78; score 3, 4.16, score 4-5, 4.19; vs. score 0, P < 0.05). Mets was an independent risk factor for development of aortic plaque after multivariate adjustment. In conclusion, Mets may deteriorate development of aortic arch plaque which causes atherothrombotic stroke.
    Preview · Article · Aug 2013 · European Heart Journal
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    ABSTRACT: It is well known that transesophageal echocardiography (TEE) is useful for evaluating left atrial appendage (LAA) function, but TEE is a semi-invasive procedure. Many clinical studies have shown a close relationship between LAA thrombus formation and left atrial (LA) mechanical remodeling. Left atrial (LA) strain assessed by two-dimensional speckle tracking echocardiography is a new tool to evaluate LA function. However, the association of LA strain and LAA function remains to be fully determined. We performed transthoracic and transesophageal echocardiography in 58 consecutive patients with acute ischemic stroke within 7 days of onset and sinus rhythm at TEE performed (40 males, mean age 71±11 years). Longitudinal LA strain was obtained using two-dimensional speckle tracking imaging at each LA segment, and peak systolic strain (S-LAs) was calculated by averaging the results for each segment. Eight patients had LAA thrombus and/or severe LAA spontaneous echo contrast (LAA-SEC). S-LAs was significantly lower in patients with LAA dysfunction than in those without (34.5±12.5 vs. 15.9±7.2%, P<0.01). S-LAs was significantly correlated with LAA eV (r=0.466, p<0.01). The optimal cut off value of S-LAs for predicting LAA dysfunction was determined for 21% (Figure). In patients with LAA dysfunction, 7 patients had low S-LAs. In those 6 patients (86%) had history of paroxysmal atrial fibrillation before stroke onset. Multivariate logistic regression analysis showed that S-LAs was an independent predictor of LAA thrombus and/or LAA-SEC (odds ratio 1.758, p<0.01). In conclusion, decreased S-LAs was independently associated with LAA dysfunction and thrombus formation in patients with acute ischemic stroke and sinus rhythm at echocardiography
    No preview · Article · Aug 2013 · European Heart Journal
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    ABSTRACT: Background: Though sleep disordered breathing (SDB) is a prevalent comorbidity and associated with poor outcomes in patients with chronic heart failure (CHF), SDB tends to be overlooked especially in non-overweight patients. The aim of the present study was to examine whether cardio-ankle vascular index (CAVI), which has been shown to be elevated in patients with SDB, predicts severe SDB in non-overweight CHF patients. Methods and results: We performed nocturnal sleep polygraphy and CAVI in 87 consecutive non-overweight CHF patients (body mass index (BMI) <25 kg/m2). The exclusion criteria were age of <20 or >90 years old, under oxygen therapy or supplementation, and end-stage renal disease. We defined that apnea-hypopnea index (AHI) of 30 times/h or higher as severe SDB. CHF patients with severe SDB included more males and had higher BMI, higher serum uric acid, and higher CAVI compared with those without severe SDB. The receiver operating characteristic curve showed the area under the curve of CAVI for severe SDB was 0.779 (cut-off value, 8.6; sensitivity and specificity, 84% and 66%, respectively). In multivariate logistic regression analysis, CAVI was an independent predictor of severe SDB (per 1SD increase, odds ratio 4.177, 95% confidence interval, 1.839-11.707). CAVI correlated with AHI (r = 0.468, P<0.001), especially with obstructive and mixed apnea indices but not with central apnea index.
    Preview · Article · Aug 2013 · European Heart Journal
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    ABSTRACT: Recently, CHA2DS2-VASc score has been recommended for patients with non-valvular atrial fibrillation (NVAF) to predict the cardioembolic stroke instead of CHADS2 score. Although 1 point is assigned for female gender, it remains unclear why female patients with NVAF are susceptible to cardioembolic stroke. The purpose of this study was to investigate the association between female gender and cardioembolic risk using echocardiographic parameters in patients with NVAF. Transthoracic and transesophageal echocardiography were performed in 206 acute ischemic stroke patients with NVAF and 142 patients with paroxysmal NVAF. We divided study patients into 3 groups based on CHA2DS2-VASc score excluding sex category (score 0-1, 2-3, and 4-8). Female patients had significantly larger left atrial volume index (LAVI) than males in each group (Figure A). Patients with left atrial appendage (LAA) thrombi and/or spontaneous echo contrast (SEC) had a significantly higher LAVI compared to those without them in each group. Female patients showed a greater prevalence of LAA thrombi/SEC than males in only score 0-1 group. Patients with LAA thrombi/SEC in score 0-1 group were older and more female, and had higher LAVI compared to those without them. Multivariate logistic regression analysis revealed that LAVI but not female gender was an independent predictor of LAA thrombi/SEC. When assigning 1 point for high LAVI (≥33 ml/m2), CHADS2 score combined with LAVI more successfully risk stratified patients with NVAF than CHA2DS2-VASc score (Figure B).
    Preview · Article · Aug 2013 · European Heart Journal
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    ABSTRACT: Purpose: Oxidative stress plays a pivotal role in the progression of heart failure. Recent report showed that renal tubular damage (RTD), which is derived from renal parenchymal hypoxia, is a common risk factor for poor prognosis in patients with chronic heart failure (CHF). Thioredoxin-1 is an abundant 12.5 kDa redox-acting protein and is used as a reliable marker for oxidative stress. The aim of the present study was to determine whether plasma thioredoxin-1 level is associated with RTD and can predict cardiac prognosis in patients with CHF. Methods and results: We measured plasma thioredoxin-1 level and urinary beta 2-microglobulin-creatinine ratio (UBCR) in consecutive 156 patients with CHF and 17 control subjects. Patients were prospectively followed during a median follow-up period of 627 days. There were 44 cardiac events. RTD was defined as a UBCR ≥ 300 μg/g, as previously reported. Plasma thioredoxin-1 was increased with advancing New York Heart Association (NYHA) functional class. Patients with RTD had higher thioredoxin-1 level than those without it. In the multivariate Cox proportional hazard analysis, elevated thioredoxin-1 level was independently associated with poor outcomes in patients with CHF after adjustment of confounding factors. A Kaplan-Meier analysis demonstrated that the highest 4th quartile of thioredoxin-1 level was associated with the highest risk of cardiac events.
    Full-text · Article · Aug 2013 · European Heart Journal

  • No preview · Article · Oct 2012 · Journal of Cardiac Failure

  • No preview · Article · Oct 2012 · Journal of Cardiac Failure

  • No preview · Article · Oct 2012 · Journal of Cardiac Failure
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    ABSTRACT: The association between ongoing myocardial damage and outcomes in patients who have received an implantable cardioverter-defibrillator (ICD) is unclear. Consecutive patients with cardiomyopathy, who had received an ICD (n = 107, mean age 65 ± 11 years), were prospectively enrolled. Myocardial membrane injury (heart-type fatty acid binding protein [H-FABP] >4.3 ng/mL) and myofibrillar injury (troponin T >0.01 ng/mL) were defined using receiver operating characteristic curves. Patients were followed for a median of 33.6 months, to an end point of appropriate ICD shock or cardiac death. Myocardial membrane injury (45%) and myofibrillar injury (41%) were equally prevalent among patients with cardiomyopathy who had received ICDs. Appropriate ICD shocks or cardiac death occurred in 31% and 15% of patients, respectively. Multivariate Cox regression analysis showed that serum H-FABP levels >4.3 ng/mL, but not troponin T levels, were a significant independent prognostic factor for cardiac events (hazard ratio 5.502, 95% confidence interval 1.705-17.75, P = .004). Subgroup analysis revealed that measuring H-FABP levels was valuable for anticipating event-free survival among patients with ICDs who were receiving amiodarone. High H-FABP levels also predicted subsequent outcomes in patients who had received ICDs for primary or secondary prevention. Evaluating myocardial damage using H-FABP may be a promising tool for predicting outcomes in patients with cardiomyopathy who have received ICDs.
    No preview · Article · Jul 2012 · Journal of cardiac failure
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    ABSTRACT: It is well known that left atrial appendage (LAA) dysfunction plays an important role in the occurrence of cardioembolic stroke. The atrium is the main source of brain natriuretic peptide (BNP) in patients with atrial fibrillation (AF). We hypothesized that the plasma BNP level would be a sensitive predictor of LAA dysfunction in patients with acute ischemic stroke. Transesophageal echocardiography was performed and plasma BNP levels were measured in 223 patients (145 males, age 69 ± 14 years), within 7 days after the onset of acute ischemic stroke. None of the patients had a history of congestive heart failure. LAA thrombus was detected in 23 of 77 (30%) patients with AF. Plasma BNP levels were markedly higher in patients with cardioembolic stroke compared to those without (144 pg/ml vs. 35 pg/ml, p<0.05). Plasma BNP levels were significantly correlated with LAA emptying flow velocity regardless of sinus rhythm (R=-0.352) or AF (R=-0.436). Furthermore, among patients with cardioembolic stroke, plasma BNP levels were markedly higher in patients with cardiogenic stroke, as diagnosed by transesophageal echocardiography, than in those with cryptogenic stroke (193 pg/ml vs. 14 pg/ml, p<0.05). Multivariate logistic regression analysis showed that a BNP concentration >90 pg/ml was an independent predictor of cardiogenic stroke (odds ratio 41.39, 95% confidence interval 1.28-138; p=0.0358). Elevated plasma BNP concentrations may be a reliable surrogate marker for the prediction of LAA dysfunction and cardiogenic stroke in patients with acute ischemic stroke.
    Preview · Article · Apr 2012 · Journal of Cardiology
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    ABSTRACT: It is important to evaluate left atrial appendage (LAA) dysfunction for primary and secondary prevention of stroke in patients with atrial fibrillation (AF). LAA dysfunction can reportedly be evaluated by LAA wall velocity (LAWV) measured by transthoracic echocardiographic (TTE) imaging. The aim of this study was to examine whether TTE-LAWV can predict long-term cerebrovascular events in patients with ischemic stroke with AF. TTE imaging and transesophageal echocardiographic imaging were performed <7 days after onset in 179 consecutive patients with stroke with AF. TTE-LAWV was measured using Doppler tissue imaging at the LAA tip from the parasternal short-axis view on TTE imaging, as previously reported. All patients were followed up prospectively. Cerebrovascular events were defined as cerebrovascular death and/or recurrent ischemic stroke requiring hospitalization. There were 32 cerebrovascular events during a median follow-up period of 397 days. TTE-LAWV was significantly lower in patients with cerebrovascular events than in patients without (8.3 ± 2.8 vs 11.3 ± 4.0 cm/sec, P < .01). Cox multivariate hazard analysis showed that low TTE-LAWV (<8.7 cm/sec) was an independent predictor of cerebrovascular events (hazard ratio, 3.460; P < .05). Kaplan-Meier analysis showed that cerebrovascular event rates were significantly higher in patients with low TTE-LAWV (<8.7 cm/sec) compared with those with high TTE-LAWV (34% vs 7%, P < .01). Impaired LAA function was associated with long-term cerebrovascular events in patients with stroke with AF. TTE-LAWV may be a feasible parameter for risk stratification in patients with AF.
    No preview · Article · Feb 2012 · Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography
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    ABSTRACT: Aorto-pulmonary fistula caused by ruptured aortic aneurysm is rare and sometimes difficult to diagnose, resulting in progression of heart failure. We report a case of acute heart failure due to abrupt rupture of aortic aneurysm into the pulmonary artery. Although it is difficult to make an early diagnosis of aorto-pulmonary shunt, multi-detector computed tomography (MDCT) clearly detected this extracardiac shunt. Emergent surgical repair of aorto-pulmonary fistula was successfully achieved. MDCT is a useful modality to make an accurate diagnosis of extracardiac shunt and to decide the operative procedure non-invasively.
    Full-text · Article · Oct 2011 · Journal of Cardiology Cases
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    ABSTRACT: Left atrial volume index (LAVI) is known to reflect the duration and severity of increased left atrial pressure caused by left ventricular (LV) diastolic dysfunction. However, the prognostic value of LAVI in patients with heart failure (HF) has not been fully investigated. Transthoracic echocardiography was performed in 146 consecutive patients (78 men, 68 women; mean age 72 ± 12 y) who were hospitalized for HF. There were 45 cardiac events (32%) during a median follow-up period of 448 days. There were no significant differences in LV end-diastolic dimensions or ejection fraction between patients who did or did not have cardiac events. However, LAVI was markedly higher in patients with, than those without, cardiac events (56 ± 26 vs 44 ± 22 mL/m(2); P < .01). Kaplan-Meier analysis showed that there was a stepwise increase in risk of cardiac events with each increment of LAVI category, and LAVI >53.3 mL/m(2) correlated with the highest risk of cardiac events (log-rank test; P < .01). Multivariate Cox proportional hazard analysis showed that high LAVI was an independent predictor for cardiac events (hazard ratio 1.427; 95% confidence interval 1.024-1.934; P < .05). LAVI may be useful for stratification of risk in patients with HF.
    No preview · Article · Mar 2011 · Journal of cardiac failure
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    ABSTRACT: Atrial fibrillation is associated with ischemic stroke because of thrombi that form within the left atrial appendage (LAA). The aim of this study was to develop a new parameter for LAA function that is easily performed using transthoracic echocardiography (TTE). TTE and transesophageal echocardiography were performed in 106 patients with stroke. LAA wall motion velocity (TTE-LAWV) was measured using Doppler tissue imaging at the LAA tip. TTE-LAWV was significantly lower in patients with atrial fibrillation and LAA thrombus than in those with atrial fibrillation and no LAA thrombus and in sinus rhythm (7.5 +/- 1.9 vs 10.0 +/- 3.4 and 13.8 +/- 5.7 cm/s, respectively, P < .05). TTE-LAWV was significantly correlated with LAA emptying flow velocity (R = 0.462, P < .05). The multivariate logistic regression analysis showed that TTE-LAWV < 8.7 cm/s was an independent predictor of LAA thrombus formation (odds ratio, 9.473; 95% confidence interval, 1.172-76.55; P < .05). TTE-LAWV can noninvasively evaluate LAA dysfunction and assist in the detection of LAA thrombus.
    No preview · Article · Mar 2010 · Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography