Abstract:
OBJECTIVES:This study sought to 1) determine the location of left atrial stasis during atrial arrhythmia; 2) define the degree of stasis associated with significant risk of stroke; and 3) identify clinical or transthoracic echocardiographic data useful for predicting left atrial stasis. BACKGROUND:Prior studies suggest that stroke during atrial arrhythmia is related to stasis in either the body of the left atrium or the appendage. Recent data indicate that appendage stasis is associated with appendage thrombus formation, but stroke during atrial arrhythmia occurs frequently in the absence of appendage stasis. METHODS:Blood flow velocity was measured in multiple sites in the body of the left atrium and in the appendage by transesophageal pulsed wave Doppler echocardiography in 89 patients with atrial fibrillation or flutter. Regional velocities were related to the frequency of probable embolic stroke and to clinical and transthoracic echocardiographic variables. RESULTS:The lowest velocity region was either the posterior left atrium or the appendage. Stroke frequency increased progressively and steeply with velocity < 15 cm/s in either region; this cutoff value had an 87% sensitivity and 40% specificity for stroke. Factors related to stasis were low left atrial ejection fraction, mitral regurgitation < 3+, fibrillation (vs. type I flutter), left ventricular dilation and mitral valve area < 2.0 cm2. CONCLUSIONS:Posterior left atrial stasis appears to be as important as appendage stasis for the risk of stroke, which increases steeply with lower blood flow velocity in either region. Patients likely to have severe stasis during atrial arrhythmia are those with left ventricular dilation and low atrial ejection fraction accompanying left atrial dilation. Direct measurement of atrial velocity by transesophageal echocardiography appears to be useful for the identification of patients at risk for stroke during atrial arrhythmia.
journal_name
J Am Coll Cardioljournal_title
Journal of the American College of Cardiologyauthors
Shively BK,Gelgand EA,Crawford MHdoi
10.1016/0735-1097(96)00049-6subject
Has Abstractpub_date
1996-06-01 00:00:00pages
1722-9issue
7eissn
0735-1097issn
1558-3597pii
0735109796000496journal_volume
27pub_type
杂志文章abstract:OBJECTIVES:We tested the hypothesis that CD40 ligand (CD40L) induces a prothrombotic state by enhancing oxidative stress. BACKGROUND:Patients with hypercholesterolemia show an ongoing prothrombotic state, but the underlying mechanism is still unclear. METHODS:Circulating levels of the soluble form of CD40L (sCD40L), ...
journal_title:Journal of the American College of Cardiology
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更新日期:2005-01-04 00:00:00
abstract::Thrombolytic drugs given to patients with a mistaken diagnosis of acute myocardial infarction could produce adverse effects, although no such cases have been reported. Two patients treated with intravenous streptokinase for presumed but nonexistent acute myocardial infarction are described. Pericardial tamponade devel...
journal_title:Journal of the American College of Cardiology
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pub_type: 杂志文章,评审
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abstract::Twenty-six young pigs were infected with encephalomyocarditis virus, observed clinically, studied at intervals by noninvasive and invasive methods to assess cardiac function and eventually examined pathologically. All infected animals appeared ill, usually manifesting diminished appetite, lethargy and fever. Spontaneo...
journal_title:Journal of the American College of Cardiology
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doi:10.1016/0735-1097(92)90533-s
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abstract::The mechanism of the antianginal actions of nilvadipine was investigated in 11 patients with effort angina pectoris. Hemodynamic data were obtained by angina-limited supine multistage bicycle ergometer exercise testing before and after a single 6 mg dose of nilvadipine. Compared with chest pain during control exercise...
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更新日期:2014-04-01 00:00:00
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更新日期:2012-10-23 00:00:00
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更新日期:2013-12-24 00:00:00
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更新日期:2005-11-15 00:00:00
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doi:10.1016/s0735-1097(99)00173-4
更新日期:1999-07-01 00:00:00
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更新日期:1997-12-01 00:00:00
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更新日期:2016-08-09 00:00:00
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更新日期:1992-07-01 00:00:00
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更新日期:2009-10-06 00:00:00
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更新日期:2005-05-03 00:00:00
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更新日期:2020-12-22 00:00:00
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更新日期:2017-05-30 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
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更新日期:1992-03-01 00:00:00
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journal_title:Journal of the American College of Cardiology
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更新日期:2004-06-16 00:00:00
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pub_type: 杂志文章
doi:10.1016/0735-1097(93)90780-5
更新日期:1993-12-01 00:00:00
abstract:OBJECTIVES:We sought to compare the effects on angiogenesis and left ventricular (LV) function of adenoviral vascular endothelial growth factor-165 (AdVEGF-165) gene delivery by direct injection of AdVEGF-165 to the transplantation of skeletal myoblasts (SKMB) transfected with AdVEGF-165 in a rat model of ischemic card...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2003.12.045
更新日期:2004-05-19 00:00:00
abstract:OBJECTIVES:We sought to test the efficacy of a passive elastic containment device to reverse chronic chamber remodeling and adrenergic down-regulation in the failing heart, yet still maintaining preload reserve. BACKGROUND:Progressive cardiac remodeling due to heart failure is thought to exacerbate underlying myocardi...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(02)01890-9
更新日期:2002-06-19 00:00:00