Disparities in emptying velocity within the left atrial appendage

Ythan H. Goldberg, Sanford Gordon, Daniel M. Spevack, Garet M. Gordon

    Research output: Contribution to journalArticle

    Abstract

    Aims: Pulsed Doppler measurement of left atrial appendage (LAA) emptying velocity, a marker of left atrium contractile function, has been shown to predict success of cardioversion, thrombo-embolic risk, and maintenance of sinus rhythm after cardioversion and pulmonary vein isolation. However, in the published literature, emptying velocity measurement location is not uniform, and no standard currently exists. We assessed the hypothesis that emptying velocity when acquired near the LAA orifice differs from that at the LAA apex. Methods and Results: The study group comprised 44 patients (32 in sinus rhythm and 12 in atrial fibrillation) who were able to complete a non-emergent transoesophageal echocardiography. Pulsed Doppler recordings were obtained with the sample volume first positioned 1 cm from the LAA orifice, and then positioned within 1 cm of the LAA apex. At each location, we calculated the average of the peak end-diastolic LAA emptying velocity from five consecutive cardiac cycles. LAA orifice emptying velocity was higher than the apex emptying velocity in all patients. The median velocity at the orifice was 72 cm/s, which was 45 higher than the median velocity at the apex (43 cm/s, P < 0.001). Lower LAA emptying velocity at the orifice was associated with a larger discrepancy between orifice and apex velocities. The ratio of orifice to apex velocity did not vary with orifice velocity. Multivariate analysis demonstrated that clinical patient characteristics were not significant predictors of the discrepancy between orifice and apex velocities. Conclusion: LAA emptying velocity is greater at the LAA orifice compared with the LAA apex. Higher, more easily measured velocity and greater variability observed with orifice measurements make it the location of choice for research and clinical applications.

    Original languageEnglish (US)
    Pages (from-to)290-295
    Number of pages6
    JournalEuropean Journal of Echocardiography
    Volume11
    Issue number3
    DOIs
    StatePublished - 2010

    Fingerprint

    Atrial Appendage
    Electric Countershock
    Pulmonary Veins
    Transesophageal Echocardiography
    Heart Atria
    Atrial Fibrillation
    Multivariate Analysis
    Maintenance

    Keywords

    • Atrial fibrillation
    • Atrial function
    • Left atrial appendage
    • Transoesophageal echocardiography

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine
    • Radiology Nuclear Medicine and imaging
    • Medicine(all)

    Cite this

    Disparities in emptying velocity within the left atrial appendage. / Goldberg, Ythan H.; Gordon, Sanford; Spevack, Daniel M.; Gordon, Garet M.

    In: European Journal of Echocardiography, Vol. 11, No. 3, 2010, p. 290-295.

    Research output: Contribution to journalArticle

    Goldberg, Ythan H. ; Gordon, Sanford ; Spevack, Daniel M. ; Gordon, Garet M. / Disparities in emptying velocity within the left atrial appendage. In: European Journal of Echocardiography. 2010 ; Vol. 11, No. 3. pp. 290-295.
    @article{6809cc3d9afe4873b7d96ed73a07970b,
    title = "Disparities in emptying velocity within the left atrial appendage",
    abstract = "Aims: Pulsed Doppler measurement of left atrial appendage (LAA) emptying velocity, a marker of left atrium contractile function, has been shown to predict success of cardioversion, thrombo-embolic risk, and maintenance of sinus rhythm after cardioversion and pulmonary vein isolation. However, in the published literature, emptying velocity measurement location is not uniform, and no standard currently exists. We assessed the hypothesis that emptying velocity when acquired near the LAA orifice differs from that at the LAA apex. Methods and Results: The study group comprised 44 patients (32 in sinus rhythm and 12 in atrial fibrillation) who were able to complete a non-emergent transoesophageal echocardiography. Pulsed Doppler recordings were obtained with the sample volume first positioned 1 cm from the LAA orifice, and then positioned within 1 cm of the LAA apex. At each location, we calculated the average of the peak end-diastolic LAA emptying velocity from five consecutive cardiac cycles. LAA orifice emptying velocity was higher than the apex emptying velocity in all patients. The median velocity at the orifice was 72 cm/s, which was 45 higher than the median velocity at the apex (43 cm/s, P < 0.001). Lower LAA emptying velocity at the orifice was associated with a larger discrepancy between orifice and apex velocities. The ratio of orifice to apex velocity did not vary with orifice velocity. Multivariate analysis demonstrated that clinical patient characteristics were not significant predictors of the discrepancy between orifice and apex velocities. Conclusion: LAA emptying velocity is greater at the LAA orifice compared with the LAA apex. Higher, more easily measured velocity and greater variability observed with orifice measurements make it the location of choice for research and clinical applications.",
    keywords = "Atrial fibrillation, Atrial function, Left atrial appendage, Transoesophageal echocardiography",
    author = "Goldberg, {Ythan H.} and Sanford Gordon and Spevack, {Daniel M.} and Gordon, {Garet M.}",
    year = "2010",
    doi = "10.1093/ejechocard/jep216",
    language = "English (US)",
    volume = "11",
    pages = "290--295",
    journal = "European Heart Journal Cardiovascular Imaging",
    issn = "2047-2404",
    publisher = "Oxford University Press",
    number = "3",

    }

    TY - JOUR

    T1 - Disparities in emptying velocity within the left atrial appendage

    AU - Goldberg, Ythan H.

    AU - Gordon, Sanford

    AU - Spevack, Daniel M.

    AU - Gordon, Garet M.

    PY - 2010

    Y1 - 2010

    N2 - Aims: Pulsed Doppler measurement of left atrial appendage (LAA) emptying velocity, a marker of left atrium contractile function, has been shown to predict success of cardioversion, thrombo-embolic risk, and maintenance of sinus rhythm after cardioversion and pulmonary vein isolation. However, in the published literature, emptying velocity measurement location is not uniform, and no standard currently exists. We assessed the hypothesis that emptying velocity when acquired near the LAA orifice differs from that at the LAA apex. Methods and Results: The study group comprised 44 patients (32 in sinus rhythm and 12 in atrial fibrillation) who were able to complete a non-emergent transoesophageal echocardiography. Pulsed Doppler recordings were obtained with the sample volume first positioned 1 cm from the LAA orifice, and then positioned within 1 cm of the LAA apex. At each location, we calculated the average of the peak end-diastolic LAA emptying velocity from five consecutive cardiac cycles. LAA orifice emptying velocity was higher than the apex emptying velocity in all patients. The median velocity at the orifice was 72 cm/s, which was 45 higher than the median velocity at the apex (43 cm/s, P < 0.001). Lower LAA emptying velocity at the orifice was associated with a larger discrepancy between orifice and apex velocities. The ratio of orifice to apex velocity did not vary with orifice velocity. Multivariate analysis demonstrated that clinical patient characteristics were not significant predictors of the discrepancy between orifice and apex velocities. Conclusion: LAA emptying velocity is greater at the LAA orifice compared with the LAA apex. Higher, more easily measured velocity and greater variability observed with orifice measurements make it the location of choice for research and clinical applications.

    AB - Aims: Pulsed Doppler measurement of left atrial appendage (LAA) emptying velocity, a marker of left atrium contractile function, has been shown to predict success of cardioversion, thrombo-embolic risk, and maintenance of sinus rhythm after cardioversion and pulmonary vein isolation. However, in the published literature, emptying velocity measurement location is not uniform, and no standard currently exists. We assessed the hypothesis that emptying velocity when acquired near the LAA orifice differs from that at the LAA apex. Methods and Results: The study group comprised 44 patients (32 in sinus rhythm and 12 in atrial fibrillation) who were able to complete a non-emergent transoesophageal echocardiography. Pulsed Doppler recordings were obtained with the sample volume first positioned 1 cm from the LAA orifice, and then positioned within 1 cm of the LAA apex. At each location, we calculated the average of the peak end-diastolic LAA emptying velocity from five consecutive cardiac cycles. LAA orifice emptying velocity was higher than the apex emptying velocity in all patients. The median velocity at the orifice was 72 cm/s, which was 45 higher than the median velocity at the apex (43 cm/s, P < 0.001). Lower LAA emptying velocity at the orifice was associated with a larger discrepancy between orifice and apex velocities. The ratio of orifice to apex velocity did not vary with orifice velocity. Multivariate analysis demonstrated that clinical patient characteristics were not significant predictors of the discrepancy between orifice and apex velocities. Conclusion: LAA emptying velocity is greater at the LAA orifice compared with the LAA apex. Higher, more easily measured velocity and greater variability observed with orifice measurements make it the location of choice for research and clinical applications.

    KW - Atrial fibrillation

    KW - Atrial function

    KW - Left atrial appendage

    KW - Transoesophageal echocardiography

    UR - http://www.scopus.com/inward/record.url?scp=77951096518&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=77951096518&partnerID=8YFLogxK

    U2 - 10.1093/ejechocard/jep216

    DO - 10.1093/ejechocard/jep216

    M3 - Article

    VL - 11

    SP - 290

    EP - 295

    JO - European Heart Journal Cardiovascular Imaging

    JF - European Heart Journal Cardiovascular Imaging

    SN - 2047-2404

    IS - 3

    ER -