日本循環器学会学術集会抄録

Decreased Left Atrial Appendage Wall Velocity Correlates With the Presence of Thrombus: A Tissue Doppler Transesophageal Echocardiography Study

○加藤浩司¹,平井淳一¹,大西定司²,村北肇²,前川直美²,森川美羽²,高橋秀宏²,山本誠²,下司徹³,豊田清浩³,熊本輝彦⁴

（¹その他,²その他,³福井医科大学　第一内科,⁴福井医科大学　第三内科）

Background: Left atrial appendage (LAA) dysfunction is a major cause of thromboembolic events in patients with atrial fibrillation (AF). Methods: We performed tissue Doppler imaging by transesophageal echocardiography (TEE) in 144 consecutive patients (age 65.9±12.8 years) with a variety of cardiac diseases. LAA wall velocity toward the left atrial cavity was measured at the tip of the LAA using tissue Doppler imaging; conventional LAA parameters (flow velocity, ejection fraction, and maximum area) also were obtained. Results: Patients with AF (n=30) had lower LAA wall velocity (17±9 cm/s vs. 32±9 cm/s, p<0.001) than those in sinus rhythm (n=114). On regression analysis, LAA wall velocity correlated positively with LAA flow velocity (r=0.71, p<0.0001) and LAA ejection fraction (r=0.61, p<0.0001), and inversely with the LAA maximum area (r=-0.38, p<0.0001) and patient age (r =-0.22, p<0.01). Patients with decreased LAA wall velocity (≤23 cm/s; n=47) had higher incidences of LAA thrombus (12/47 [25%] vs. 2/97 [2%], p<0.001) and cerebral embolism (8/47 [17%] vs. 5/97 [5%], p<0.05) than those with normal LAA wall velocity (>23 cm/s; n=97). Multivariate analysis revealed that LAA wall velocity and LAA ejection fraction correlated independently with the presence of LAA thrombus (p<0.0001). Conclusion: LAA wall velocity measured by tissue Doppler TEE is an extremely useful parameter for identifying patients at high risk for thromboembolism.

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