학술논문
Oral Abstract session: Diagnosis and clinical impact of imaging in valvular heart disease: Thursday 4 December 2014, 14:00-15:30 * Location: Agora
Document Type
Article
Author
Amin, A E H; Ammar, WAA; Farrag, A A F; Elaroussy, W A E; Enache, R; Popescu, BA; Muraru, D; Piazza, R; Calin, A; Beladan, CC; Rosca, M; Nicolosi, GL; Ginghina, C; Hamadanchi, A; Goebel, B; Schmidt-Winter, C; Otto, S; Jung, C; Figulla, HR; Poerner, TC; Bandera, F; Generati, G; Pellegrino, M; Labate, V; Alfonzetti, E; Guazzi, M; Cho, EJ; Park, S-J; Lim, HJ; Yoon, HR; Chang, S-A; Lee, S-C; Park, SW; Henri, C; Dulgheru, R; Magne, J; Caballero, L; Laaraibi, S; Kou, S; Voilliot, D; Davin, L; Pierard, L; Lancellotti, P; Ancona, R; Comenale Pinto, S; Caso, P; Monteforte, I; Coppola, MG; Sellitto, V; Izzo, M; Macrino, M; Calabro, R; Lee, S; Lee, SP; Kim, HJ; Park, JB; Hong, MK; Kim, JH; Kim, HK; Kim, YJ; Sohn, DW
Source
European Journal of Echocardiography; December 2014, Vol. 15 Issue: Supplement 2 pii60-ii60, 1p
Subject
Language
ISSN
15252167; 15322114
Abstract
Purpose: Patients with rheumatic mitral stenosis (MS) are at increased risk of thromboembolic consequences. Owing to the higher risk of these complications, anticoagulant therapy is mandatory in MS associated with atrial fibrillation (AF). However, time to begin prophylactic anticoagulant therapy in normal sinus rhythm (NSR) is not yet clear. Left atrial (LA) enlargement has been proposed as potential surrogate for thrombus formation and subsequent embolization. We examined various LA echocardiographic parameters to detect possible predictors of embolization in MS and NSR. Methods: Our study included 79 patients with rheumatic MS in NSR. Case group (n=36) included patients with history of prior embolic events; while control group (n=43) included patients without history of embolization. All the studied population underwent history taking, clinical examination and ECG to rule out AF and confirm manifestations of embolization in the case group. Patients with CVS underwent bilateral carotid duplex to rule out Carotid artery stenosis. Other causes of embolization were excluded. Routine transthoracic echocardiogram (TTE) was done and LA volumes (LAV) were measured using both area-length (A-L) and prolate-ellipsoid methods. LAV maximum (end systolic; Vmax), LAV minimum (end diastolic;Vmin) and LAV at onset of atrial systole (end of P wave on surface ECG;Vp) were measured by the two methods. The LA phasic indices were calculated given the aforementioned LAVs as follows: Passive emptying volume (PEV)= Vmax-Vp, Passive emptying fraction (PEF) = PEV/Vmax, Active emptying volume (AEV)= Vp-Vmin, Active emptying fraction (AEF) = AEV/Vp and Total emptying volumes (TEV) = PEV + AEV. Comparison between case and control groups was done using two-tailed unpaired student t test for continuous variables and the Pearson's chi-square test for categorical variables. Correlations between normally distributed variables were done using Pearson correlation coefficient. p value < 0.05 was considered significant for all tests. Results: Female gender predominated the studied group (83.7%). The mean age of our population was 32.6 ± 6.7.Both groups were age and gender matched. All patients were neither diabetic nor hypertensive. Both groups had comparable degree of mitral stenosis. There was no statistical difference in LAV between both groups. However, PEF using Prolate-ellipsoid method was significantly lower in the case group (p=0.017). Conclusion: LA phasic indices may be better indicator of LA dysfunction than conventional LAV. LA PEF may be a predictor of thrombus formation and subsequent embolization in rheumatic MS and NSR.