Abstract
Left atrial appendage thrombus (LAAT) is a surrogate of thromboembolic events in patients with nonvalvular atrial fibrillation (NVAF). We aimed to investigate the risk factors for LAAT formation before catheter ablation and cardioversion beside the CHA2DS2-VASc score. In this case-control study, patients with NVAF who underwent transesophageal echocardiography (TEE) were included. Demographic data, laboratory results, and echocardiographic measurements were retrospectively collected. Logistic regression analysis was performed to determine risk factors predicting LAAT. Of the 543 included patients, LAAT was identified in 50 patients (9.2%). Multivariable logistic regression analysis for the entire cohort showed that NT-proBNP (per 500 ng/L increase, OR (95% CI): 1.09 (1.00–1.19), p = 0.038) and LDL-C (per 1 mmol/L increase, OR (95% CI): 1.70 (1.05–2.77), p = 0.032) were independently correlated with the presence of LAAT after the adjustment for CHA2DS2-VASc score and anticoagulant therapy. The subgroup analysis of patients without anticoagulant therapy also yielded similar results. Regarding patients with CHA2DS2-VASc scores ≤ 1, a higher level of LDL-C (per 1 mmol/L increase, OR (95% CI): 6.31 (2.38–16.74), p < 0.001) independently correlated with the presence of LAAT. The present study suggests that beyond CHA2DS2-VASc score, raised NT-proBNP and LDL-C are additional predictors for LAAT in NVAF patients.
Highlights
Introduction published maps and institutional affilAtrial fibrillation (AF) is the most common cardiac arrhythmia worldwide, with a currently estimated prevalence between 2–4% in adults, which is expected to continue rising in the near future [1]
It has been well recognized that the left atrial appendage thrombus (LAAT) formation is the primary cause of cardiogenic stroke in patients with nonvalvular atrial fibrillation (NVAF) [4]
As left atrial appendage thrombus (LAAT) is considered as a surrogate of thromboembolic events, in this study we aimed to investigate potential risk factors beyond CHA2DS2VASc score in predicting LAAT in patients with NVAF undergoing transesophageal echocardiography (TEE) before catheter ablation and cardioversion
Summary
Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide, with a currently estimated prevalence between 2–4% in adults, which is expected to continue rising in the near future [1]. The presence of AF is intimately correlated to cardiovascular hospitalizations and all-cause mortality, even nullifying the prognostic power of cardiac calcification in patients with multiple cardiovascular risk factors [2]. It has been well recognized that the left atrial appendage thrombus (LAAT) formation is the primary cause of cardiogenic stroke in patients with nonvalvular atrial fibrillation (NVAF) [4]. CHA2DS2-VASc score is currently the most commonly used scoring system for the risk stratification of stroke in patients with NVAF [1,5], which exhibits comparable predictive iations
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