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Prevalence and Predictors of Left Atrial Appendage Inactivity in patients of Rheumatic Mitral Stenosis in Sinus Rhythm- An observational study.
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  • Saibal Mukhopadhyay,
  • yogesh dwivedi,
  • Jamal Yusuf,
  • abhimanyu uppal,
Saibal Mukhopadhyay
G B Pant Hospital

Corresponding Author:[email protected]

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yogesh dwivedi
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Jamal Yusuf
G B Pant Hospital
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abhimanyu uppal
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GB Pant Hospital
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BACKGROUND: Systemic thromboembolism is a known complication of rheumatic mitral stenosis (RMS) in sinus rhythm (SR). Left atrial appendage (LAA), the commonest site of thrombus formation is usually hypocontractile (inactive) in such patients. We aimed to study the prevalence of LAA inactivity (LAAI) in severe RMS and assess its independent predictors. METHODS: The study population consisted of 100 patients of severe RMS in sinus rhythm. Transthoracic and transesophageal echocardiography were done to assess LAA contractile function. Patients with LAA-peak emptying velocity <25 cm/sec were defined as having LAAI. RESULTS: The mean age of study subjects was 31.66±8.69 years and 56% were females. 73% patients had LAAI (Group A), while remaining 27% had normal LAA function (Group B). Mitral-valve area (MVA) and lateral annulus systolic velocity (Sa-wave) were significantly lower while mean pressure gradient across mitral valve (MGMV) and serum fibrinogen were significantly higher (all p-values <0.001) in group A patients. On multivariate regression analysis, MGMV (p<0.001), Sa-wave (p=0.02) and serum fibrinogen (p=0.005) were independent predictors of LAAI. Optimal cut-off values of MGMV, Sa-wave and serum fibrinogen for predicting LAAI were 11.5mmHg, 6.8cm/sec and 300mg/dL respectively.67(90.55%) patients in group A compared to 13(48.1%) in group B had LA/LAA smoke. LAAI was the only independent predictor of left atrium (LA)/LAA smoke and associated thrombus. CONCLUSION: There is high prevalence of LAAI in patients of severe MS in SR. MGMV, Sa-wave and serum fibrinogen levels are independent predictors of LAAI. LAAI is an independent predictor of LA/LAA smoke and associated thrombus.
01 Jun 2021Submitted to Echocardiography
01 Jun 2021Submission Checks Completed
01 Jun 2021Assigned to Editor
08 Jun 2021Reviewer(s) Assigned
22 Aug 2021Review(s) Completed, Editorial Evaluation Pending
22 Aug 2021Editorial Decision: Revise Major
20 Sep 20211st Revision Received
22 Sep 2021Submission Checks Completed
22 Sep 2021Assigned to Editor
22 Sep 2021Reviewer(s) Assigned
23 Sep 2021Review(s) Completed, Editorial Evaluation Pending
27 Sep 2021Editorial Decision: Accept
Nov 2021Published in Echocardiography volume 38 issue 11 on pages 1860-1869. 10.1111/echo.15223