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SUMMARYWith the wide spread prevalence of non-rheumatic atrial fibrillation and associated complications, non invasive tests have to be evaluated for their ability to predict these possible cardiogenic thromboembolic complications, which is a very important issue for diagnostic, therapeutic and prognostic reasons, for example Doppler echocardiographic & TDI study because of its ability to detect myocardial thickness and wall motion in real time.Yet, transesophageal echocardiography suffers from the disadvantages of being invasive method relatively expensive and experience dependent, although it’s high degree of accuracy.This has increased the need for development of a noninvasive method for evaluation of left atrial function and probability for thromboembolic complications in AF patients’ particularly nonrheumatic ones.TDI is a new imaging modality, based on color Doppler imaging principles and allows quantification of intramural myocardial velocities (Goreson, et al. 1997).The current study comprised 50 patients with non-rheumatic atrial fibrillation and 30 normal volunteers as a control group.The control group (30 normal volunteers) included 16 males (53.3 %) and 14 females (46.7 %) with age range 40-70 [58.8 + 8.2 yrs.].The patients group (50 patients with non-rheumatic atrial fibrillation) included 28 patients free from thromboembolic manifestations (stroke, TIA’s or other peripheral thromboembolisms] with a mean age ± S.D (59.4 ± 9.6 yrs) and 22 patients with positive past history and / or in actual state of thromboembolic manifestations (stroke, TIA’s or other peripheral thromboembolisms) with a mean age = 64.1±7.8 yrs.Group (II) included:-9 patients with fine AF (31%).- 13 with coarse AF (61.9%).-5 (22.7%) free from LA smoke.-6(27.3 %%) with fine smoke.-11(50%) with dense smoke.-LA d (45.4 ± 5.4).- L.V.E.F. % (45.3 ± 9.9).- E/Em ratio (4.1 ± 1.7).According to results of Doppler echocardiographic & TDI study, those patients were divided into:*22 patients, (beside the 30 healthy ones): LA Smoke = Grade 0.*16 patients: LA Smoke = Grade I.* 12 patients: LA Smoke = Grade II.* 28 patients: with E/Em ratio (7.6±4.1).* 22 patients: with E/Em ratio (4.1±1.7).Comparing the results of echo-Doppler examination and TDI examination. We found that:• Group II showed LA-d [45.4 ± 5.4] higher than in group I and control, [32.2 ± 4.8 --- 32.8 ±4.4 respectively.• Regarding LA smoke (SEC) group II showed five (22.7%) free, six (27.3 %) with fine smoke and 11(50%) with dense smoke, while in group I it was [17(60.7%) free 10(35.7%) with fine smoke and one (3.6%) and control 100% free].• Ejection fraction was significantly low in group II [45.3 ± 9.9%] compared with normal (control) [65.8 ± 4.9%] and group I [52.7 ±8.6%].• Both control and group I show higher (E) wave velocity mean ± S.D. = 94.03 ± 10.6 and 99.07±16.7respectively compared to group II mean (E) 62.5 ± 8.2(p =<0.001).• Early diastolic mitral annular velocity (Em) was statistically insignificant (f. value = 2.5 and p. >0.05) in groups understudy.• However E/Em ratio was low in group II [4.1 + 1.7] compared to group I [7.6± 4.1] and control [6.6 ± 1.2] (p. =<0.001).- No significant correlation was observed between understudy groups regarding Em wave.- There was a good statistically significant difference regarding E/Em ratio in understudy groups.Sensitivity of TDI E/Em ratio, (GII compared to GI). = 86.4 %.Specificity of DTI = 67.9%.Positive predictive value = 67.9%.Negative predictive value =86.4%.Test accuracy = 76%.CONCLUSIONWe can conclude that:Doppler echo had become a useful noninvasive technique for the evaluation and diagnosis of different cardiac malfunctions or diseases. One of these is the thromboembolic complications in non-rheumatic atrial fibrillation patients. Introduction of pulsed wave TDI helped much in achieving this goal.According to our study, four parameters were found very helpful predictors of thromboembolic complications in non-rheumatic atrial fibrillation patients; left atrial dimension (?30mm), left atrial smoke grade II, ejection fraction (? 59 %), and E/Em ratio (? 6.1).The most significant predictor of thromboembolic complications of nonrheumatic atrial fibrillation found to be; E/Em ratio ( ? 6.1 is predictive) followed by LA smoke (grade II).RECOMMENDATIONConventional Doppler echocardiography can’t be used for the prediction of possible cardiogenic thromboembolic complications in non-rheumatic atrial fibrillation and this problem is solved with the use of the invasive method TEE, however we recommend the use of TDI via making use of (E/Em ratio), avoiding the now commonly indicated TEE disadvantage.TDE is a non invasive technique that can be used for prediction of possible cardiogenic thromboembolic complications in non-rheumatic atrial fibrillation and is found to be, according to our study, E/Em ratio have 86.4% sensitivity and 67.9% specificity plus the positive predictive value (PPV) = 67.5%, negative predictive value (NPV) =86.4%, and accuracy was about 76%. Beside, avoiding complication of TEE especially in severely ill patients during hospital admission.
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