Moderate-to-severe or Severe Mitral Regurgitation is Associated with Higher Left Atrial Appendage Emptying Velocity
Carine Tabak, Sarah Baghdadi, Ross Smith, Riya Parikh, Matthew Bajaj, Robert Enders, Cody Uhlich, Ethan Morgan, Sania Jiwani, Amulya Gupta, Amit NoheriaIntroduction:
Atrial fibrillation (AF) increases the risk of stroke due to thromboembolism from the left atrial appendage (LAA). LAA emptying velocity (LAAev) is measured with transesophageal echocardiograms (TEEs) and is a surrogate for LAA thrombosis and stroke risk. Although the literature is conflicting, we hypothesized that mitral regurgitation (MR) would increase turbulence in left atrium and increase LAAev.
Methods:
TEE imaging and reports from 2016 to 2022 at The University of Kansas Medical Center were reviewed to obtain LAAev. MR was assessed using echocardiography reports. Univariate and multivariate linear and logistic regressions were used to analyze the association between moderate-to-severe or severe MR (>moderate MR) and LAAev. The multivariate models were adjusted for age, sex, and significant univariate predictors.
Results:
The study included 995 TEEs (38.1% female, mean age 71.3 ± 12.7 years) with 817 (82.1%) having a history of AF. The mean LAAev was 41.6 ± 21.0 cm/s with > moderate MR present in 50 (5.0%) patients, associated with 7.8 ± 3.0 cm/s increase in LAAev (
Conclusions:
Our results support an independent association between MR and increased LAAev, suggesting a possible protective role of MR in AF-related cardioembolic stroke. This merits further validation before incorporation in cardioembolic risk-stratification systems.