P2455Global peak left atrial longitudinal strain - a good predictor of left atrial appendage thrombus in patients in sinus rhythm with heart failure and very low left ventricular ejection fraction

Abstract

Abstract The aim of this study was to determine if various clinical and transthoracic echocardiography data including left atrial strain analysis could predict the presence of left atrial appendage thrombus (LAAT) in heart failure (HF) patients with very low left ventricular ejection fraction (LVEF), sinus rhythm at presentation and no history of atrial fibrillation or any other established indication for anticoagulation. Material and methods Sixty-seven patients with HF, LVEF <25%, sinus rhythm and not anticoagulated were included. Transesophageal echocardiography was performed in all patients to allow detection of LAAT. Results LAAT was found in 21 (31.3%) patients. Global peak left atrial longitudinal strain (PALS) was the best predictor of LAAT presence in univariate logistic regression analysis (Gini index 0.65, AUC 0.83) – data for other variables are presented in the Table 1. In the multivariate model after the inclusion of global PALS no other available variable could significantly improve it. The global PALS value of 8% was a good discriminator of LAAT presence with OR 26.2 (95% CI 6.8–103) if global PALS was <8% at p<0.001. Table 1. Univariable models for potential risk factors for LAAT incidence in the study population OR (95% CI) p-value Gini index Age 1.01 (0.96–1.06) 0.71 0.02 Heart rate 0.99 (0.94–1.03) 0.57 0 Body surface area 0.66 (0.03–12.45) 0.78 0.03 Ischaemic HF etiology 2.11 (0.73–6.07) 0.17 0.18 Hypertension 1.10 (0.39–3.09) 0.86 0.02 Diabetes 0.59 (0.18–1.89) 0.37 0.11 Chronic kidney disease 1.29 (0.46–3.65) 0.63 0.06 Prior stroke or TIA (transient ischemic attack) 1.75 (0.35–8.63) 0.49 0.06 LA diameter 0.96 (0.3–3.03) 0.94 0.02 LAVI (LA volume index) 1.06 (1.01–1.11) 0.01 0.46 LVEF 0.99 (0.87–1.12) 0.88 0.07 E/A 1.28 (0.79–2.09) 0.31 0.1 E/e' 0.98 (0.91–1.04) 0.44 0.15 Global PALS 0.43 (0.29–0.64) <0.001 0.65 Global PACS (peak atrial contraction strain) 1.42 (0.91–2.21) 0.13 0.27 Conclusions LAAT has been a relatively common finding in this group of HF patients and PALS has shown prognostic potential in LAAT identification.