[Left Atrial Strain Independently and Incrementally Predicts High Risk Thromboembolic Findings Over CHA2DS2-VASc Score and BNP].

Background: Left atrial longitudinal strain(LAs) is a novel and useful parameter of LA function and reflecting thromboembolic risk. CHA₂DS₂-VASc score and brain natriuretic protein (BNP) are also used for risk stratifica- tion. However, little is known about the impact of LAs on stroke risk stratification over these parameters. In this study, we aimed to examine whether LAs has independent and incremental risk stratification over them.

Methods: We studied 97 consecutive patients (age: 66 ± 12, 70 males) who underwent transesophageal echocardi- ography for evaluation of left atrial appendage (LAA) thrombus with persistent or paroxysmal atrial fibrillation. We assessed whether patients had spontaneous echo contrast (SEC) or not. Patients with LAA thrombus or sponta- neous echo contrast (SEC) were defined as high risk. LAs was assessed by averaging the segments measured in the 4- and 2-chamber views by transthoracic echocardiography.

Results: Among the 97 patients, 51(53%) patients had sinus rhythm and 36 were with SEC. Although LAs (21.0 ?9.0%), CHA₂DS₂-VASc score (2.7± 1.7) and BNP were mutually associated, only LAs and CHA₂DS₂-VASc score were independent predictors of high thromboembolic risk but BNP not. In nested logistic regression model anal- yses, predictive ability of a model with CHA₂DS₂-VASc score was improved by the addition of BNP (p =0.004) and further by adding LAs (p =0.027).

Conclusion: LAs predicts independently and incrementally LAA thrombus or SEC over CHA₂DS₂-VASc score and BNP, suggesting that LAs serves as a functional predictor for future thromboembolism. [Original].