Dataset Information

Inverse Correlation Between Left Atrial Appendage Function and CHA₂DS₂-VASc Score in Patients with Atrial Flutter.

ABSTRACT: Impaired left atrial appendage ejection fraction (LAA-EF) and peak LAA flow velocity (LAA-FV) are associated with high thromboembolic risks in patients with atrial fibrillation (AF). Herein, we examined LAA function among patients with atrial flutter (AFL) stratified by the CHA₂DS₂-VASc score using transesophageal echocardiography (TEE). Of 231 consecutive patients with typical AFL, 84 who fulfilled the inclusion criteria were enrolled. Among them, 57 had ongoing AFL and were divided into the isolated AFL (n?=?38) and AFL with paroxysmal AF (PAF) (n?=?19) groups, depending on whether they had sporadic AF before TEE. The remaining 27 patients with spontaneous sinus rhythm during TEE were designated as controls. Both the LAA-FV (31.9?cm/s vs. 51.5?cm/s, P?=?0.004) and LAA-EF (28.4% vs. 36.5%, P?=?0.024) measured during AFL were significantly lower in the AFL?+?PAF group than in the isolated AFL group. Significant inverse correlations between the CHA₂DS₂-VASc score and LAA-EF were identified in the AFL (P?=?0.008) and AFL?+?PAF (P?=?0.032) groups. We observed progressive LAA dysfunction in patients with AFL?+?PAF compared with that in patients with isolated AFL, and the LAA-EF was inversely correlated with the CHA₂DS₂-VASc score in these patients. Our findings may have implications on the application of thromboprophylactic therapy in patients with AFL.

SUBMITTER: Wu MY

PROVIDER: S-EPMC6883047 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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Inverse Correlation Between Left Atrial Appendage Function and CHA2DS2-VASc Score in Patients with Atrial Flutter.

Wu Mei-Yao MY Lin Yen-Nien YN Wu Hung-Pin HP Huang Ying-Ying YY Chen Jan-Yow JY Lin Kuo-Hung KH Chang Kuan-Cheng KC

Scientific reports 20191128 1

Impaired left atrial appendage ejection fraction (LAA-EF) and peak LAA flow velocity (LAA-FV) are associated with high thromboembolic risks in patients with atrial fibrillation (AF). Herein, we examined LAA function among patients with atrial flutter (AFL) stratified by the CHA2DS2-VASc score using transesophageal echocardiography (TEE). Of 231 consecutive patients with typical AFL, 84 who fulfilled the inclusion criteria were enrolled. Among them, 57 had ongoing AFL and we ...[more]

PMID: 31780786

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Project description:BackgroundAtrial fibrillation (AF) is a common arrhythmia, and its most severe and dreaded complication is stroke. The CHA2DS2-VASc score is currently recommended for stroke risk assessment in AF. We aimed to explore the relationship between atrial FDG uptake and stroke and whether atrial FDG uptake could provide incremental value above the CHA2DS2-VAS score to predict stroke in AF by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT).Materials and methodsFrom September 2017 to December 2020, we retrospectively enrolled 230 patients (115 with AF and 115 without AF as the non-AF group, matched for the date of PET/CT examination and the basic characteristics of the patient) who underwent 18F-FDG PET/CT due to tumor screening or preoperative staging after prolonged fasting and followed up for at least 12 months from the date of PET/CT examination; the endpoint event is the occurrence of stroke. We visually and quantitatively analyzed 18F-FDG uptake in the right and left atria (RA/LA), right and left atrial appendage (RAA/LAA), right and left ventricle (RV/LV), and collected clinical features. In addition, according to the endpoint event (stroke), the enrolled population was divided into the stroke group and non-stroke group, and relevant clinical features and atrial FDG uptake indicators of the two groups were analyzed. Univariate and multivariate Cox regression analyzes were used to analyze the risk factors of stroke events. The Kaplan-Meier survival curve of atrial FDG uptake was drawn, and the log-rank method was used to compare the differences in the survival curves of the two groups. Receiver operating characteristic (ROC) curves were used to examine the discriminatory power of atrial FDG uptake in predicting stroke and determine whether the addition of atrial FDG uptake improves predictive value beyond the CHA2DS2-VASc score for stroke.ResultsIn the AF group, more than half of patients had RA FDG uptake and one-fifth had LA FDG uptake, while one patient had RA FDG uptake and two patients had LA FDG uptake in the non-AF group. In quantitative analysis, the maximum standardized uptake value (SUV max ) of the RA and LA in the AF group was significantly higher than that of the non-AF group (all P < 0.001). We followed up the patients for 28 ± 10 months, and finally, 31 patients had stroke. In the stroke group, atrial fibrillation, RA SUV max , RAA SUV max , LAA SUV max , age ≥ 75 years, and left atrial dilation were significantly higher than those of the non-stroke group (all P < 0.05). Multivariate Cox regression analysis showed that high RA SUV max (RA SUV max ≥ 2.62) was an independent risk factor for stroke (HR = 4.264, 95% CI 1.368-13.293, P = 0.012). By using the log-rank test, patients with high RA SUV max had a significantly higher incidence of stroke compared with patients with low RA SUV max (P < 0.001). Addition of high RA SUV max to the CHA2DS2-VASc score could predict stroke more effectively, with a larger AUC 0.790 (P < 0.001).ConclusionThis study found a significant correlation between atrial FDG uptake and AF, especially in RA. Meanwhile, RA FDG uptake is an independent risk factor for stroke, and patients with high RA SUV max have a significantly higher risk of stroke. Moreover, RA FDG uptake improves prediction of stroke above the CHA2DS2-VASc score in patients with AF.

Dataset Information

Inverse Correlation Between Left Atrial Appendage Function and CHA₂DS₂-VASc Score in Patients with Atrial Flutter.

Publications

Inverse Correlation Between Left Atrial Appendage Function and CHA<sub>2</sub>DS<sub>2</sub>-VASc Score in Patients with Atrial Flutter.

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