Predictors of left atrial appendage thrombus in heart failure patients at sinus rhythm

Abstract

Purpose: It is a well recognized fact that thromboembolic events are frequent in patients with congestive heart failure. Left atrial appendage (LAA) may be a crucial source of thromboembolism in patients with dilated cardiomyopathy. The purpose of this study was to identify clinical and echocardiographic predictors of LAA thrombus in sinus rhythm (SR) patients with dilated cardiomyopathy of mild to moderate systolic dysfunction. Methods: This was a prospective, cross-sectional study conducted on 101 SR patients with dilated cardiomyopathy of ischemic and non-ischemic etiology at mild to moderate systolic dysfunction, which were not under anticoagulation therapy. Demographics, history data, ECG, chest X-ray, transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were completed for every patient. Results: Mean patient age was 58.1±12.7 years, 69% were men and 75% were taking Aspirin prior to entering the study. Mean partial thromboplastin time (PTT), LV end-diastolic diameter, LV ejection fraction, LV length in diastole, LA diameter, LAA maximal area were: 25.5±4.2 s, 66.6±6.1 mm, 39±6.4%, 7.7±0.9 cm, 45.9±4.9 mm and 4.7±1.6 cm2, respectively. LAA thrombus was detected in 46 (45.5%) patients, with 87% of them being small and 13% moderate size thrombi. The overall prediction model performed with logistic regression analysis revealed PTT, more prominent LV length in diastole and larger LAA maximal area as significant independent factors of LAA thrombus presence (Table 1). We established the value 8.0 cm as cut-off value for LV length in diastole associated with high frequency of LAA thrombi. View this table: Prediction model for LAA thrombus Conclusions: The high frequency of LAA thrombi detected in our patients with dilated cardiomyopathy demonstrates the necessity for more extensive use of TEE and potential broader use of anticoagulation therapy. We suggest that SR patients with dilated cardiomyopathy whose LV length in diastole measured by TTE is above 8.0 cm should be considered for TEE.