Left atrial appendage dysfunction in acute embolic stroke young patients with sinus rhythm: Correlation with Tissue Doppler mitral annular systolic velocity

Abstract

Background: Trans-esophageal echocardiogram (TEE) is a gold standard test for diagnosis of left atrial (LA) appendage function. Aim: To evaluate left atrial appendage (LAA) dysfunction using mitral annular systolic velocity measured by tissue Doppler imaging “Sm” in acute embolic stroke young patients with sinus rhythm. Methods: Transthoracic (TTE) and transesophageal echocardiography (TEE) were performed in 70 consecutive patients with sinus rhythm without obvious left ventricular dysfunction within 2 weeks after embolic stroke. Two groups were identified: LAA dysfunction [LAA emptying peak flow velocity (LAA-eV) <0.55 m/s, n = 28, age 52 ± 11 years] and without LAA dysfunction (LAA-eV ≥ 0.55 m/s, n = 42, age 54 ± 10 years) on TEE. Tissue Doppler mitral annular systolic velocity “Sm” was obtained in apical four chambers view on TTE and D-dimer level estimated for all patients. Results: Sm was significantly lower in patients with than in those without LAA dysfunction (P < 0.0001). There was a significant correlation between Sm, LAVI, LAEF%, E/A ratio and LAA-eV in all selected patients groups. The optimum cut-off value of Sm for predicting LAA dysfunction was below or equal 8 cm/s (sensitivity 89.6% and specificity 94.2%). Conclusion: Tissue Doppler mitral annular systolic velocity is an independent non-invasive easy predictor of LAA dysfunction and significantly correlated with LAA-eV (p < 0.0001) in acute embolic stroke young patients with sinus rhythm.

Keywords

• Stroke
• Left atrial appendage
• Mitral annular systolic velocity