Incremental value of left atrial mechanical dispersion over CHA2 DS2 -VASc score in predicting risk of thrombus formation.

Abstract

To assess the potential ability of two-dimensional speckle tracking analysis (STE) during atrial fibrillation (AF) to identify patients with LA appendage thrombi (LAAT). This study involved 93 patients with AF (39% female, 67.1±9.5years) who were referred for a clinical indication for transesophageal echocardiography (TEE). TEE revealed LAAT in 39 (42%) patients. We analyzed standard parameters of the left ventricle (LV) and LA in transthoracic echocardiography. Using STE, we assessed LV global longitudinal strain (LVGLS), peak atrial longitudinal strain (PALS), and intra-atrial asynchrony. The PALS was calculated using the global strain curve (GPALS) and as the mean of peaks derived from segmental strain curves (MPALS). Patients were comparable with regard to the clinical data. A subgroup with LAAT had lower LV ejection fraction (LVEF) and a lower absolute value of the LVGLS, as well as greater impairment in the LA standard parameters, PALS, and asynchrony. Receiver operating characteristic curve analysis revealed that the LVEF of 30% (P<.001), the LVGLS of -7% (P<.0001), the GPALS of 11% (P<.005), and the LA asynchrony of 22% (P<.01) were the optimal cutoff values for distinguishing both subgroups. LA asynchrony, LVEF, and LVGLS were independently associated with the presence of LAAT in multivariate analyses, and PALS had additional significance over the CHA2 DS2 -VASc score. Left ventricular systolic dysfunction characterized by both LVEF and LVGLS is an independent factor for LAAT. LA asynchrony provides additional diagnostic value for discriminating between patients with and without LAAT.