Echocardiographic Evaluation Of Left Atrial Function And Left Atrial Appendage Thrombus In Patients With Non-valvular Atrial Fibrillation

ObjectiveA variety of echocardiographic techniques were used to measure left atrial function and to evaluate its correlation with the incidence of left atrial appendage thrombus in patients with non-valvular atrial fibrillation.Methods100 patients with non-valvular atrial fibrillation were divided into thrombus group(50 cases)and non thrombus group(50 cases)according to transesophageal echocardiography(TEE).The left atrial diameter(LAd)was measured by transthoracic echocardiography(TTE),the left atrial end diastolic volume(LAEDV),left atrial end systolic volume(LAESV),left ventricular end diastolic volume(LVEDV),left ventricular end systolic volume(LVESV)were measured by two-dimensional echocardiography,left atrial ejection fraction(LAEF)and left ventricular ejection fraction(LVEF)were calculated.Systolic peak velocity(s’ LA)and early diastolic peak velocity(e’LA)were measured by pulsed tissue Doppler(PW-TDI),systolic maximum strain(S)were measured by tissue Doppler strain imaging(SI).Two-dimensional speckle tracking(2D-STI)was used to measure the left atrial strain in four chamber,three chamber and two chamber sections,and to record the global systolic longitudinal strain(GLS).Real time three-dimensional echocardiography(RT-3DE)was used to record left atrial ejection fraction(3D-EF).Blood flow velocity(LAA-V),width of left atrial appendage(LAA-W)and depth of left atrial appendage(LAA-D)were measured.The baseline data of patients were recorded in detail,and the clinical and echocardiography indexes of the two groups were compared.ResultsCompared with non thrombus group,LAD increased and LAEF decreased in thrombus group(P<0.05);S in thrombus group was smaller than that in non thrombus group(P<0.05);3D-EF in thrombus group was smaller than that in non thrombus group,the difference was statistically significant(P<0.05);GLS in2D-STI thrombus group was smaller than that in non thrombus group,the difference was statistically significant(P<0.05).There was no significant difference in LAA-W and LAA-D between the two groups(P>0.05).Compared with the non thrombus group,LAA-V in the thrombus group was significantly reduced,and the difference was statistically significant(P<0.05).ROC curve analysis showed that LAEF(AUC 0.78,95%CI 0.65-0.91,P=0.001),GLS(AUC0.94,95%CI 0.89-1.00,P=0.000)and 3D-EF(AUC 0.89,95% CI 0.81-0.99,P=0.000)had predictive effects on left atrial appendage thrombus.Multivariate logistic regression analysis showed that the LAEF(OR 1.7,95%CI 0.45-16.9,P=0.008),3D-EF(OR 6.4,95%CI 1.06-16.9,P=0.039),GLS(OR 18.0,95%CI1.38-35.68,P=0.028)were related factors of left atrial appendage thrombous,the correlation between GLS≤12% and left atrial appendage thrombus was the greatest.ConclusionsThe whole function of left atrial in patients with non-valvular atrial fibrillation with left atrial thrombus is lower than that in patients with non thrombus.Echocardiography,as a routine examination method,can reflect left atrial function quickly and simply.GLS obtained from 2D-STI can better reflect the change of left atrial function in a variety of echocardiography techniques,and has potential value in predicting left atrial thrombus.