The Differences in Left Atrial Appendage Remodeling Between Diabetic and Non-Diabetic Patients Transesophageal 3D Echocardiography Study - The 65th Annual Conference of the Israel Heart Society & The Israel Society of Cardiothoracic Surgery, 24-25 April 2018

Chaim Yosefy Department of Cardiology, Barzilai Medical Center Campus, Ashkelon, Israel Faculty of Health Science, Ben-Gurion University, Israel Marina Pery Department of Cardiology, Barzilai Medical Center Campus, Ashkelon, Israel Faculty of Health Science, Ben-Gurion University, Israel Piltz Xavier Department of Cardiology, Barzilai Medical Center Campus, Ashkelon, Israel Faculty of Health Science, Ben-Gurion University, Israel Boris Brodkin Department of Cardiology, Barzilai Medical Center Campus, Ashkelon, Israel Faculty of Health Science, Ben-Gurion University, Israel Vladimir Khalameizer Department of Cardiology, Barzilai Medical Center Campus, Ashkelon, Israel Faculty of Health Science, Ben-Gurion University, Israel

Introduction: Diabetes Mellitus (DM) is independently associated with an overall 40% increase in risk of atrial fibrillation (AF). Possible mechanisms that link DM and AF occurrence include prothrombotic state, endothelial dysfunction, platelet hyperactivity, angiogenesis, and atherogenesis, which all account for left atrial (LA) structural and electrical remodeling. This may also be responsible for the increased risk for stroke by 150–400% for patients with diabetes. Ninety percent of clots in patients with nonvalvular AF occur in the left atrial appendage (LAA).The shape and location of LAA allow for stasis of blood in atrial fibrillation. No studies are known about the differences in LAA shape and function between diabetic and non-diabetic patients, which may be another mechanism for the increased stroke risk.

Patients and Methods: We retrospectively reviewed a group of 60 subjects in our center. All subjects had Real Time 3 Dimensional Transesophageal Echocardiography (RT3DTEE) before AF ablation or LAA device closure from July 2015 to November 2017. All were in sinus rhythm, aged 68±10y, 32/28 M/F, and were studied by RT3DTEE using EPIQ 7, a 3D Echo machine (Borthel Phillips). Significant Valvular disease, mechaical valves and infected valves were excluded. Diameters of the LAA were measured using Yosefy rotational method for the maximal LAA diameter, depth, orifice flow, and area.

Results: Comparing to non-diabetic patients, the diabetic patients revealed larger LAA diameters (D1and D2 (2.08±0.53 vs. 1.72±0.43 cm and 2.37±0.6 vs. 1.93±0.57 cm, respectively, p<0.05), Depth (2.61±0.76 and 2.13±0.58 cm, respectively, p<0.05), and Orifice Area (4.2±1.77 and 3.04±1.43 cm², respectively; p<0.05); and lower orifice flow velocity (34.9±9.94 and 45.82±20.5 cm/sec, respectively, p<0.05).

Conclusions: Using RT3DTEE method, diabetic patients showed significantly larger diameters of LAA orifice with slower orifice flow velocity, which may suggest worse remodeling and another mechanism for increased stroke risk in diabetic AF patients.