Abstract 18370: Role and Potential Impact of TEE in Detecting Markers of Thromboembolism in Non Valvular Atrial Fibrillation Patients with a CHADS2 score = 0?

Abstract

Background: Transesophageal echocardiography (TEE) parameters (left atrial appendage, LAA thrombus or spontaneous echocardiographic contrast (SEC), aortic atheroma (AAA) are powerful markers of thromboembolism (TE) in non-valvular atrial fibrillation (NVAF) patients. However, the prevalence and potential impact of these abnormalities have not been evaluated in patients at very low risk of TE. We evaluated TEE-detected LASEC, thrombus and AAA in AF patients referred for cardioversion and analyzed the subgroup of patients with a CHADS 2 score=0. Methods: Among 763 consecutive patients hospitalized for NVAF, prior to cardioversion, TEE was systematically performed within 24h after admission; 205 patients had a CHADS 2 score=0. The following parameters were described: presence and severity of LASEC, LA thrombus, aortic atheroma (AAA). Results: Mean age was 54.5 ± 13.5 years. AF was paroxysmal in 101 patients (49.3%), persistent in 82 (40.0%) and permanent in 22 (10.7%). Transthoracic echocardiography showed LVEF<40% in 12 (5.9%) and median of mean LA area was 18 (15-23) cm 2 . LA thrombus was found in 1 patient (0.5%), LASEC in 60 (29.3%), classified as mild in 43 (21.0%), moderate in 14 (6.8%) and severe in 3 (1.5%). AAA was present in 6 patients (2.9%). The table compares some baseline characteristics in patients with (LAASEC/thrombus or aortic atheroma ≥ 4 mm) or without TEE abnormalities, defined as an endpoint. In the multivariate analysis, age (OR, 1.04, 95% CI 1.01-1.07), non paroxysmal AF (OR, 3.23, 95% CI 1.54-6.78) and LA area (OR, 1.08, 95% CI 1.02-1.16) were predictors of TEE-detected LASEC/thrombus or aortic atheroma. Conclusions: TEE prior to cardioversion in NVAF found TEE-detected risk markers of thromboembolism (LASEC/thrombus or aortic atheroma) in one third of patients with a CHADS 2 score = 0.