Paroksismal Atrial Fibrilasyonlu Hastalarda Strokun Transözefagial Ekokardiyografik Prediktörleri

Year 2019, , 597 - 601, 16.12.2019

Tarık Yıldırım , Eyüp Avcı , Fatih Akın , Seda Elçim Yıldırım İbrahim Altun , Mustafa Özcan Soylu

https://doi.org/10.31832/smj.587975

Abstract

Amaç Atrial fibrilasyonda trombüs oluşumunun en sık olduğu yer sol atrial apendiksdir (SAA). Bu çalışmada amacımız paroksismal atrial fibrilasyonu (PAF) olup strok geçiren ve geçirmeyen hastalarda SAA fonksiyonlarını ortaya çıkarmaktı.

Gereç ve YöntemlerStrok nedeni ile veya atrial septal defekt, patent foramen ovale şüphesi ile transözefagial ekokardiyografi yapılan 74 hasta çalışmaya alındı. Tüm hastalara 24 saatlik EKG holter, 2 boyutlu ekokardiyografi ve trans özefagial ekokardiyografi uygulandı.

Bulgular İki grup arasında diyabet, hipertansiyon, sigara içimi ve kreatinin seviyesi açısında fark saptanmadı. Strok grubunda strok olmayan gruba göre daha düşük SAA dolum velositesi(26.8±5, 38.9±5) (p<0.001), daha düşük kontraksiyon velositesi (30.8±6, 46.6±7) (p<0.001) ve daha büyük SAA alanı (2.7±0.6, 2.4±0.4) (p=0.03) saptandı. SAA kontraksiyon velositesi (p=0.013) ve dolum velositesi (p=0.045) Stoke için bağımsız prediktörler olarak tespit edildi.

Sonuç Bulgularımız düşük SAA kontraksiyon velositesi ve düşük dolum velositesinin strok ile ilişkili olduğunu gösterdi. Bu indeksler strok oluşumunun bağımsız prediktörleri idi. Bu sonuçlar gelecekte yapılacak çalışmalarla desteklenirse, PAF’ı olup strok geçirmemiş hastalarda düşük SAA kontraksiyon ve dolum basıncı mevcutsa olumsuz sonuçları azaltmak için daha fazla medikal tedavi düşünülmelidir.

Keywords

Atrial fibrilasyon, strok, sol atrial apendiks

Supporting Institution

yok

Project Number

yok

Transesophageal Echocardiographic Predictors of Stroke in Patients with Paroxysmal Atrial Fibrillation

Abstract

Objective The left atrial appendage  is the most source of thrombus formation in atrial fibrillation.The aim of this study was to find out left atrial appendage functions in patients with PAF with or without stroke.

Materials and Methods This study included74 paroxysmal atrial fibrillation patients who were performed transesophageal echocardiography for evaluation of stroke or who have suspicion doubt of atrial septal defect and patent foramen ovale. All patients had undergone 24 hours electrocardiography Holter recorder, 2 dimensional echocardiography, transesophageal echocardiography.

Results Thereare no differences between the groups for diabetes, hypertension, smoking, hyperlipidemia and creatinine levels. Patients with stroke group had lower left atrial appendagefilling velocity (26.8±5, 38.9±5) (p<0.001), had lower left atrial appendagecontraction velocity (30.8±6, 46.6±7) (p<0.001) and had bigger left atrial appendagearea (2.7±0.6, 2.4±0.4) (p=0.03) than without stroke group. Left atrial appendagecontraction velocity (p=0.013) and filling velocity (p=0.045) are the independent predictors of stroke.

Conclusion Our findings showed that stroke is associated with low filling velocity and low contraction velocity of left atrial appendage. Our findings suggest that this indices are independent predictors of stroke. If these results are confirmed in future studies, patients with paroxysmal atrial fibrillation without stroke and with low filling velocity and low contraction velocity of left atrial appendageshould receive more medical attention, to reduce unfavorable outcomes.

Keywords

Atrial fibrillation, stroke, left atrial appendage

Project Number

yok

References

• 1. Naccarelli GV, Varker H, Lin J, Schulman KL. Increasing prevalence of atrial fibrillation and flutter in the United States. Am J Cardiol 2009;104:1534–9.2. Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH et al. Management of patients with atrial fibrillation (compilation of 2006 ACCF/AHA/ESC and 2011 ACCF/AHA/HRS recommendations): a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013;61:1935–44.3. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016;37(38):2893-962.4. Marini C, De Santis F, Sacco S, Russo T, Olivieri L, Totaro R et al. Contribution of atrial fibrillation to incidence and outcome of ischemic stroke : results from a population-based study. Stroke 2005;36:1115-9.5. Roy D, Marchand E, Gagné P, Chabot M, Cartier R. Usefulness of anticoagulant therapy in the prevention of embolic complications of atrial fibrillation. Am Heart J 1986;112:1039–43.6. Blackshear JL, Odell JA. Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann Thorac Surg 1996;61:755–9.7. Scherr D, Dalal D, Chilukuri K, Dong J, Spragg D, Henrikson CA et al. Incidence and predictor of left atrial thrombus prior to cathater ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2009;20:379-84. 8. No authors listed. The Stroke Prevention in Atrial Fibrillation Investigators Committee on Echocardiography. Transesophageal echocardiographic correlates of thromboembolism in high risk patients with nonvalvular atrial fibrillation. Ann Intern Med, 1998;128:639–47.9. Agmon Y, Khandheria BK, Gentile F, Seward JB. Echocardiographic assesment of the left atrial appendage. J Am Coll Cardiol 1999;34:1867-77.10. Zhu MR, Wang M, Ma XX, Zheng Dy Zhang YL. The value of left atrial strain and strain rate in predicting left atrial appendage stasis in patientswith nonvalvular atrial fibrillation. Cardiol J. 2018;25(1):87-96.11. Beigel R, Wunderlich NC, Ho SY, Arsanjani R, Siegel RJ. The left atrial Appendage: Anatomy, function, and noninvasive evaluation. JACC 2014;7:1251-65.12. Mügge A, Kühn H, Nikutta P, Grote J, Lopez JA, Daniel WG. Assessment of left atrial appendage function by biplane transesophageal echocardiography in patients with nonrheumatic atrial fibrillation: identification of patients at inreased embolic risc. J Am Coll Cardiol. 1994;23:599-607.13. Agmon Y, Khandheria BK, Meissner I, Schwartz GL, Petterson TM, O’Fallon WM et al. Left atrial appendage flow velocities in subjects with normal left ventricular function. Am J Cardiol 2000;86:769-73.14. Taguchi Y, Takashima S, Hirai T, FukudaN, Ohara K, Nakagawa K et al. Significant impairment of left atrial function in patients with cardioembolic stroke caused by paroxysmal atrial fibrillation. Intern Med 2010;49:1727–32.15. Matsumoto Y, Morino Y, Kumagai A, Hozawa M, Nakamura M, Terayama Y et al. Characteristics of anatomy and function of the left atrial appendage and their relationships in patients with cardioembolic stroke: A 3-D dimensional transesophageal echocardiographic study. J Stroke Cerebrovasc Dis 2017;26:470-9.