Mehwish Shabeen

Badr Al Samaa Medical Centre, UAE

Title: La Anteroposterior Diameter (Laapd) As Predictor of La/Laa Thrombus In Patients With Severe Mitral Stenosis And Sinus Rhythm

Biography

Mehwish Shabeen is a Specialist Cardiologist with extensive expertise in adult cardiology and cardiac imaging. She earned her MBBS degree followed by an FCPS in Adult Cardiology. After completing her specialization, she worked as a post-fellow cardiac imaging specialist at the National Institute of Cardiovascular Diseases. Currently, she is working as a Specialist Cardiologist at Badr Ul Samaa Medical Centre in Dubai. She has three publications and is currently working on her fourth research project.

Abstract

Objective: This study was planned to evaluate the association between LAAPD and LA/LAA thrombus among patients with severe mitral stenosis and sinus rhythm undergoing echocardiography.

Methodology: This cross-sectional study was carried out at the echocardiography department of the “National Institute of Cardiovascular Diseases”, Karachi, Pakistan, from March 2024 to August 2024. The study included patients of either gender, aged up to 65 years, who had severe mitral stenosis (mitral valve area <1.5 cmZ) and were in sinus rhythm as confirmed by ECG. Receiver-operating characteristic (ROC) curve analysis was employed to identify the optimal cut-off values for left atrial appendage pressure dimension (LAAPD), using Youden's Index J to determine the most accurate threshold and evaluate the sensitivity and specificity of the measurements.

Results: Out of 145 patients, 114 (78.6%) were female, while overall mean age was 44.5±8.0 years. LA/LAA thrombus was present in 29 (20.0%) patients. The mean LAAPD was 44.5±8.0 mm, and LA enlargement was observed in 111 (76.6%) patients. Thrombus prevalence was higher in those with LA enlargement (26.1% vs. 0%, p<0.001). For males, the AUC for LAAPD predicting thrombus was 0.823 (95% CI: 0.554–1.092), and for females, it was 0.778 (95% CI: 0.688–0.868), with no significant difference (p=0.756). Overall, LAAPD measurements between 42.5 mm and 43.5 mm demonstrated strong predictive accuracy for LA/LAA thrombus.

Specifically, for males, an LAAPD threshold of 50.5 mm yielded the highest Youden's J Index of 0.608, reflecting optimal predictive performance. In females, an LAAPD of 42.5 mm achieved the highest Youden's J Index of 0.417, indicating significant predictive capability.

Conclusion: LAAPD is a significant predictor of LA thrombus in severe mitral stenosis with sinus rhythm. Integrating LAAPD measurements into clinical practice could improve risk stratification and management.