Abstract
Introduction: Atrial fibrillation remains highly prevalent in the US with over 6 million diagnosed individuals. Discordant atrial contraction inherent to atrial fibrillation results in stagnant blood flow and increases the risk for thrombus formation particularly within the left atrial appendage (LAA). Anticoagulation is the mainstay of intracardiac thrombus prevention and is initiated based on the CHAD 2 S 2 -VASc risk score that does not account for LAA morphology. The relationship between LAA structural characteristics and thrombus development remains poorly understood. Hypothesis: We hypothesized that in patients with atrial fibrillation, LAA structural characteristics correlate with the presence of thrombus. Methods: We performed a retrospective case-control study of 151 subjects with a history of atrial fibrillation who underwent transesophageal echocardiogram (TEE) to evaluate the LAA for pre-cardioversion indication or Watchman screening evaluation. Subjects discovered to have LAA thrombus on TEE defined the study case group (n = 74) while control subjects did not have LAA thrombus (n = 77). Baseline demographics and echocardiographic characteristics were collected for all subjects. Results: Subjects without thrombus were older than those with thrombus (thrombus: 68.6 ± 13.1 years, no thrombus: 74.7 ± 9.2 years, p = 0.001 ). LAA ostial cross-sectional area was smaller in subjects with thrombus than those without thrombus (thrombus: 251.1 ± 117.4 mm 2 , no thrombus: 332.9 ± 171.2 mm 2 , p < 0.001 ). This finding remained significant in both unadjusted and adjusted logistic regression models ( Table 1 ). CHA 2 DS 2 -VASc score did not significantly differ in those with or without thrombus (thrombus: 4.4 ± 1.8, no thrombus: 4.3 ± 1.7, p = 0.822). Conclusions: Smaller LAA ostial cross-sectional area correlates with thrombus formation. Consideration of LAA structural characteristics may improve precision of anticoagulation management.
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