Correlation between Mitral Annular Systolic Velocity and Left Atrial Appendage Function in Mitral Stenosis

ABSTRACT

The left atrial appendage is a long, tubular and trabecular structure and has a narrow junction with the left atrium. The left atrial appendage has been the focus of clinicians’ interests, because it is a potential site for the development of thrombus in several diseases. Aim: To study the correlation between mitral annular systolic velocity and left atrial appendage function in mitral stenosis. Methods: 60 patient with moderate to severe Mitral Stenosis with MVO <1.5 cm2 were included in the study. All eligible patients underwent a detailed history and clinical examination. A 12 lead electrocardiogram was taken. Echocardiographic evaluation was done for all patients Atrial fibrillation diagnosis was based on the electrocardiogram. Result: There was a positive correlation between these two variables which are statistically significant. (r=0.944, p-value<0.001). There was a positive correlation between left atrial appendage emptying velocity and mitral annular late diastolic velocity in patients in sinus rhythm. (r=0.695(p<0.001) The cut off value of peak annulus systolic velocity which is derived from the analysis of the receiver operator characteristic curve is 13.5cm/sec. The area under the curve is 0.840 with confidence interval 0.689 to 0.936 and the p-value<0.001. This value predicts inactive LAA (Laaev<25cm/sec) with a sensitivity of 92% and specificity of 96.5%. Conclusion: The systolic and diastolic annular velocities obtained by Doppler tissue imaging are reduced in patients with mitral stenosis. There is a positive correlation between annular systolic and left atrial appendage emptying velocities in mitral stenosis. The annular systolic velocity is an independent predictor for the presence of inactive left atrial appendage in mitral stenosis patients with sinus rhythm.