RESULTS:
A total of 154 patients of heart failure with reduced ejection fraction
meeting the inclusion criteria were consecutively enrolled in the study.
There were 91 male and 63 female patients, with a mean age of 55.71 ±
12.48 years (range, 27-75 years) and there were 119 patients of DCMP
(77.27%) and 35 patients were ICMP (22.72%). The baseline demographic
and echocardiographic characteristics of the study population are shown
in Table 1
Among the study population, 27 patients (17.53%) had hypertension, 23
patients (14.93%) were diabetic, and 13 patients (8.44%) had chronic
kidney disease (CKD). Five patients (3.25%) were diagnosed with atrial
fibrillation with a controlled ventricular rate, while 149 patients
(96.75%) were in normal sinus rhythm. The echocardiographic
characteristics of the study participants are summarized in Table 2.
During transthoracic echocardiography (TTE) examination, the mean left
ventricular ejection fraction (LVEF) was found to be 29.87 ± 5.8, the
mean left ventricular global longitudinal strain (GLS) was -8.46 ± 2.74,
the mean mitral E/e’ ratio was 13.33 ± 2.74, and the mean left atrial
appendage wall velocity was 14.26 ± 5.56. Furthermore, in our study, the
mean level of NT pro-BNP, a biomarker for heart failure, was measured to
be 980.51 ± 611.77. These findings provide important baseline
characteristics and echocardiographic parameters of the study
population, allowing for a comprehensive understanding of their
cardiovascular health and aiding in the analysis of their cardiac
function and status.
We successfully measured LAAWV using transthoracic TDE in a total of 154
patients. The obtained LAAWV values ranged from 2 to 26 cm/s, with a
mean LAAW velocity of 14.26±5.56 cm/s. When comparing patients with
dilated cardiomyopathy (DCMP) and those with ischemic cardiomyopathy
(ICMP), we observed significant differences in mean LAAW velocity.
Specifically, patients with DCMP had a mean LAAW velocity of 12.67±5.27
cm/s, while patients with ICMP had a significantly higher mean LAAW
velocity of 19.69±1.82 cm/s. Notably, we found a positive correlation
between left atrial appendage wall velocities obtained using TDI and
left ventricular ejection fraction (LVEF) (r= 0.634, p<0.001).
Additionally, we explored the relationship between LAAW velocity and
other relevant parameters. We discovered a good inverse correlation
between LAAW velocity and left ventricular global longitudinal strain
(LV GLS) as well as the serum marker NT pro-BNP (r= -0.671,
p<0.001 and r= -0.659, p=0.007, respectively). Furthermore,
our study demonstrated a strong inverse correlation between LAAWV values
and the mitral E/e’ ratio, which is indicative of diastolic dysfunction
(r= -0.756, p<0.001). However, interestingly, we did not find
any statistically significant correlation between LAAWV and age (r=
0.121, p=0.135). This suggests that LAAWV may not be influenced
significantly by age in the studied patient population. Overall, our
study highlights the clinical relevance of measuring LAAW velocity using
transthoracic TDE, as it showed significant associations with various
important cardiac parameters, including LVEF, LV GLS, NT pro-BNP, and
the mitral E/e’ ratio. These findings underscore the potential of LAAWV
as a valuable non-invasive tool for assessing cardiac function and
understanding the pathophysiology of dilated cardiomyopathy and ischemic
cardiomyopathy.