ISSN 2149-2263 | E-ISSN 2149-2271
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Effect of left ventricular diastolic dysfunction on left atrial appendage function and thrombotic potential in nonvalvular atrial fibrillation [Anatol J Cardiol]
Anatol J Cardiol. 2014; 14(3): 256-260 | DOI: 10.5152/akd.2014.4833

Effect of left ventricular diastolic dysfunction on left atrial appendage function and thrombotic potential in nonvalvular atrial fibrillation

Muhammed Bora Demirçelik1, Mustafa Çetin2, Hülya Çiçekcioğlu2, Özgül Uçar3, Mustafa Duran4
1Deparment of Cardiology, Faculty of Medicine, Fatih University, Ankara-Turkey
2Clinic of Cardiology, Ankara Numune Education and Researching Hospital, Ankara-Turkey
31Clinic of Cardiology, Ankara Numune Education and Researching Hospital, Ankara-Turkey
4Clinic of Cardiology, Kayseri Education and Researching Hospital, Kayseri-Turkey

Objective: We aimed to investigate effects of left ventricular diastolic dysfunction on left atrial appendage functions, spontaneous echo contrast and thrombus formation in patients with nonvalvular atrial fibrillation. Methods: In 58 patients with chronic nonvalvular atrial fibrilation and preserved left ventricular systolic function, left atrial appendage functions, left atrial spontaneous echo contrast grading and left ventricular diastolic functions were evaluated using transthoracic and transoesophageal echocardiogram. Patients divided in two groups: Group D (n=30): Patients with diastolic dysfunction, Group N (n=28): Patients without diastolic dysfunction. Categorical variables in two groups were evaluated with Pearson’s chi-square or Fisher’s exact test. The significance of the lineer correlation between the degree of SEC and clinical measurements was evaluated with Spearman’s Correlation analysis. Results: Peak pulmonary vein D velocity of the Group D was significantly higher than the Group N (p=0.006). However, left atrial appendage emptying velocity, left atrial appendage lateral wall velocity, peak pulmonary vein S, pulmonary vein S/D ratio were found to be significantly lower in Group D (p=0.028, p<0.001, p<0.001; p<0.001). Statistically significant negative correlation was found between spontaneous echo contrast in left atrium and left atrial appendage emptying, filling, pulmonary vein S/D levels and lateral wall velocities respectively (r=-0.438, r=-0.328, r=-0.233, r=-0.447). Left atrial appendage emptying, filling, pulmonary vein S/D levels and lateral wall velocities were significantly lower in SEC 2-3-4 than SEC 1 (p=0.003, p=0.029, p<0.001, p=0.002). Conclusion: In patients with nonvalvular atrial fibrillation and preserved left ventricular ejection fraction, left atrial appendage functions are decreased in patients with left ventricular diastolic dysfunction. Left ventricular diastolic dysfunction may constitute a potential risk for formation of thrombus and stroke.

Keywords: diastolic dysfunction, atrial appendage function, thrombus formation, atrial fibrillation

Nonvalvüaler atriyum fibrilasyonu olanlarda sol atriyal appendiks fonksiyonları ve trombotik potansiyel üzerine sol ventrikül diyastol disfonksiyonunun etkisi

Muhammed Bora Demirçelik1, Mustafa Çetin2, Hülya Çiçekcioğlu2, Özgül Uçar3, Mustafa Duran4
1Deparment of Cardiology, Faculty of Medicine, Fatih University, Ankara-Turkey
2Clinic of Cardiology, Ankara Numune Education and Researching Hospital, Ankara-Turkey
31Clinic of Cardiology, Ankara Numune Education and Researching Hospital, Ankara-Turkey
4Clinic of Cardiology, Kayseri Education and Researching Hospital, Kayseri-Turkey

Amaç: Nonvalvüler atriyal fibrilasyonu olan hastalarda sol atriyal appendiks fonksiyonları, spontan eko kontrast ve trombüs oluşumu üzerine sol ventrikül diyastolik disfonksiyonunun etkilerini araştırmayı amaçladık. Yöntemler: Nonvalvüler atriyal fibrilasyon ve sol ventrikül sistolik fonksiyonu korunmuş 58 hastada, sol atriyal appendiks fonksiyonları, sol atriyal spontan eko kontrast (SEK) ve ventrikül diyastolik fonksiyonları transtorasik ve transözofajiyal ekokardiyografi ile değerlendirildi. Hastalar Grup D (n=30): diyastolik disfonksiyonu olan hastalar, Grup N (n=28) diyastolik disfonksiyon olmayan hastalar olarak iki gruba ayrıldı. Bulgular: Zirve pulmoner ven D velositesi Grup N’den anlamlı olarak yüksek bulunmuştur (p=0,006). Ancak, atriyal apendiks boşalma velositesi, sol atriyal apendiks lateral duvar velositesi, zirve pulmoner ven S, pulmoner ven S/D oranı Grup N’de anlamlı olarak düşüktü (p=0,028, p<0,001, p<0,001, p<0,001). Sol atriyum içinde spontan eko kontrast ile sol atriyal apendiks boşalma, dolma velositeleri, pulmoner ven S/D oranı ve lateral duvar hızları arasında ters korelasyon saptandı (r=-0,438, r=-0,328, r=-0,233, r=-0,447). Sol atriyal apendiks boşalma, dolma, pulmoner ven S/D oranı ve lateral duvar hızları grade 2-3-4 SEK’i olan grupta grade 1 SEK’i olan gruba göre anlamlı olarak daha düşüktü (p=0,003, p=0,029, p<0,001, p=0,002). Sonuç: Nonvalvüler atriyal fibrilasyon ve korunmuş sol ventrikül ejeksiyon fraksiyonu olan hastalarda, sol atriyal appendiks fonksiyonları sol ventrikül diyastolik disfonksiyonu olan hastalarda azalmıştır. Sol ventrikül diyastolik disfonksiyonu trombüs ve felç oluşumu için potansiyel bir risk teşkil edebilir.

Anahtar Kelimeler: diyastolik disfonksiyon, atriyal apendiks fonksiyonları, trombüs oluşumu, atriyal fibrilasyon

Muhammed Bora Demirçelik, Mustafa Çetin, Hülya Çiçekcioğlu, Özgül Uçar, Mustafa Duran. Effect of left ventricular diastolic dysfunction on left atrial appendage function and thrombotic potential in nonvalvular atrial fibrillation. Anatol J Cardiol. 2014; 14(3): 256-260
Manuscript Language: English


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