Left Atrial Appendage Emptying Velocity and Coexisting Echocardiographic Findings in Severe Rheumatic Mitral Stenosis: A Single-Centre Cross-Sectional Observational Study

Abstract

Objectives: To describe the distribution of left atrial appendage emptying velocity (LAAEV) and the coexistence of atrial fibrillation (AF), spontaneous echo contrast (SEC), and left atrial appendage (LAA) thrombus among patients with severe rheumatic mitral stenosis undergoing transoesophageal echocardiography (TEE). Methodology: This single-centre, cross-sectional observational study included 50 consecutive adults with severe rheumatic mitral stenosis who underwent clinically indicated TEE at the Department of Cardiology, Punjab Institute of Cardiology, Lahore, Pakistan, between 21 May and 31 July 2026. Severe rheumatic mitral stenosis was defined by characteristic rheumatic valve morphology and a mitral valve area ≤1.5 cm² measured using two-dimensional echocardiographic planimetry. LAAEV was assessed using pulsed-wave Doppler and categorized a priori as <20, 20–29, 30–39, and ≥40 cm/s for descriptive purposes. AF, SEC, and LAA thrombus were also recorded. Results: The mean age of participants was 37.3 ± 9.4 years; 45 (90%) were female, and the mean mitral valve area was 1.01 ± 0.22 cm². LAAEV was <20 cm/s in 18 patients (36%; 95% CI: 22.9–50.8%), 20–29 cm/s in 11 (22%; 95% CI: 11.5–36.0%), and 30–39 cm/s in 21 (42%; 95% CI: 28.2–56.8%); no participant had an LAAEV ≥40 cm/s. Overall, 29 patients (58%; 95% CI: 43.2–71.8%) had LAAEV <30 cm/s. AF was present in 29 patients (58%; 95% CI: 43.2–71.8%), SEC in 32 (64%; 95% CI: 49.2–77.1%), and LAA thrombus in 15 (30%; 95% CI: 17.9–44.6%). Conclusion: Lower predefined LAAEV categories were frequently observed in this cohort of patients with severe rheumatic mitral stenosis, alongside substantial frequencies of AF, SEC, and LAA thrombus. These findings are descriptive and do not establish statistical association, prediction, causality, or prognostic utility. Larger prospective studies retaining continuous patient-level LAAEV measurements and longitudinal thromboembolic outcomes are warranted.