Clinical and echocardiographic predictors of left atrial appendage dysfunction in patients with mitral stenosis in sinus rhythm

Abstract

Background Mitral stenosis (MS) causes left atrial (LA) appendage (LAA) dysfunction resulting in reduced LAA flow velocities. Low LAA peak emptying velocity (PEV), determined by transesophageal echocardiography, is a risk for thrombus formation and systemic embolism. Objective We sought to investigate various clinical and echocardiographic predictors of low LAA blood flow velocities. Methods A total of 44 patients with newly diagnosed MS were classified into two groups on the basis of the presence of high (PEV ≥ 46 cm/s) or low (PEV < 46 cm/s) LAA flow profile on Doppler transesophageal echocardiography. LAA flow velocities were measured to be 27.38 ± 8.17 cm/s in patients with LAA dysfunction and 70.75 ± 16.71 cm/s in high-flow profile ( P < .0001). Simultaneous 12-lead electrocardiogram was used to measure P waves. Results P maximum, P dispersion, and LA diameter were significantly higher in patients with low LAA PEV (n = 32) than in those with high LAA PEV (111.87 ± 16.93 vs 96.66 ± 14.97, P = .0084; 73.12 ± 20.7 vs 49.16 ± 9.96, P < .0001; 46.06 ± 4.384 vs 38.08 ± 7.42 mm, P = .004; respectively). Patients with MS and low LAA blood flow had smaller mitral valve area compared with those with high LAA blood flow velocity (1.48 ± 0.431 vs 1.85 ± 0.442 cm 2, P = .02). Male sex, spontaneous echocontrast, and thrombus were more frequent in patients with low LAA PEV {7 [21.87%] vs 5 [41.66%], P = .026; 21 [65.62%] vs 4 [33.3%], P = .088; 4 [12.5%] vs none; respectively}. Mild MS was more frequent in patients with high blood flow velocity {6 [27.2%] vs 14 [63.6%], P = .03}. Conclusion At linear regression analysis, only P-wave dispersion and LA diameter predicted the LAA mechanical dysfunction reflected as low LAA PEVs.