Abstract
Predicting left atrial appendage thrombus (LAAT) in chronic nonvalvular atrial fibrillation remains challenging despite the fact that several predictive models have been proposed to date. In this study, we sought to develop new and simpler models for LAAT prediction in chronic nonvalvular atrial fibrillation. The study enrolled 144 patients with chronic nonvalvular atrial fibrillation who underwent transesophageal echocardiography for LAAT detection. We examined the association of LAAT incidence with the CHA2DS2-VASc score and echocardiographic parameters pertaining to the left atrium (LA), including diameter, volume index, strain, and strain rate measured on speckle tracking echocardiography. LAAT was found in 24.3% of patients (39/144). The following parameters had good diagnostic performance for LAAT: LA volume index >57 mL (area under the curve (AUC), 0.72; sensitivity, 77.1%; specificity, 64.2%), LA positive strain ≤6.7% in the four-chamber view (AUC, 0.84; sensitivity, 77.1%; specificity, 77.1%), and LA negative strain rate >−0.73 s−1 in the four-chamber view (AUC, 0.83; sensitivity, 85.7%; specificity, 70.6%). The CHA2DS2-VASc score alone had a low predictive value for LAAT in this population (χ2 = 3.53), whereas the combination of CHA2DS2-VASc score with LA volume index had significant association and better predictive value (χ2 = 12.03), and the combination of CHA2DS2-VASc score with LA volume index and LA positive strain or negative strain rate in the four-chamber view had the best predictive ability for LAAT (χ2: 33.47 and 33.48, respectively). We propose two novel and simple models for noninvasive LAAT prediction in patients with chronic nonvalvular atrial fibrillation. These models combine the CHA2DS2-VASc score with LA volume index and LA longitudinal strain parameters measured on speckle tracking echocardiography in the four-chamber view. We hope these simple models can help with decision-making in managing the antithrombotic treatment of such patients, whose risk of stroke cannot be determined solely based on the CHA2DS2-VASc score.
Highlights
Atrial fibrillation (AF) is the most prevalent arrhythmia in the general population, especially among the elderly [1]
In European countries, the prevalence of AF ranges from 1.9% in Italy, Iceland, and England, to 2.3% in Germany, and 2.9% in Sweden. ese numbers are expected to increase in the near future [2]. e prevalence of AF is lower in Asian than in Western countries, having been reported at approximately 1.6% in Japan [3] and 1.0% in Korea [4]
This group of patients often presented with persistent episodes of atrial tachyarrhythmia which were associated with elevated asymmetric dimethylarginine (ADMA) and downregulates endothelial nitric oxide synthase. ese factors were shown to be the risks of oxidative stress, vascular injury, and endothelial dysfunction [25]. is might be the reason why the prevalence of left atrial appendage thrombus (LAAT) was higher in our study (24.3%) than in the previous studies [26, 27]
Summary
Atrial fibrillation (AF) is the most prevalent arrhythmia in the general population, especially among the elderly [1]. AF is associated with increased risk of ischemic stroke, systemic thromboembolism, and transient ischemic attack, which ranges from 1.5% in individuals aged 50–59 years to 23.5% in individuals aged 80–89 years [5]. Recent studies indicate that cardioembolic stroke accounts for 16%–30% of cases of ischemic stroke [6]. Compared to non-AF stroke, cardioembolic stroke due to AF is associated with higher risk of mortality and worse outcomes [7]. Erefore, it is of utmost importance to clarify the risk factors for AF stroke and adequately stratify patients according to stroke risk. Erefore, it is important to adequately assess the LA appendage. Recent studies have shown that STE can be applied for measuring LA strain and strain rate [9,10,11]
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