Risk factors of left atrial appendage thrombus in patients with non-valvular atrial fibrillation.

Yaowu Liu,Long Chen,Didi Zhu,Qianxing Zhou,Yeqian Zhu,Yunyun Xiao,Liqun Ren

doi:10.1515/med-2021-0009

Abstract

ObjectiveTo investigate the risk factors of left atrial appendage thrombus (LAAT) in patients with non-valvular atrial fibrillation (AF).MethodsWe collected the clinical data of patients with non-valvular AF who underwent transesophageal echocardiography (TEE) at the Zhongda Hospital of Southeast University between January 2016 and June 2019. The patients were divided into two groups, LAAT and non-LAAT. We performed comparative analysis, receiver operating characteristic (ROC) curve analysis and logistic regression analysis to estimate the risk factors of LAAT.ResultsA total of 442 patients with non-valvular AF were enrolled in the study. LAAT was detected by TEE in 20 cases (4.7%). Compared with patients without LAAT, patients with LAAT had higher CHA2DS2-VASc scores (3 vs 2, p = 0.001), higher values of D-dimer (180.0 vs 90.0 μg/L, p = 0.003), larger LA anteroposterior diameters (50.5 vs 41.0 mm, p < 0.001) and higher ratios of non-paroxysmal AF (85.0% vs 23.6%, p < 0.001). ROC curve analysis revealed that the cutoff value of LA anteroposterior diameter was 49.5 mm. After adjusting for other confounders, logistic regression analysis showed that enlarged LA (anteroposterior diameter ≥49.5 mm) and non-paroxysmal AF were independently associated with higher risks of LAAT (OR = 7.28, 95% CI: 2.36–22.47; OR = 8.89, 95% CI: 2.33–33.99, respectively). The proportions of LAAT in patients with larger LA (anteroposterior diameter ≥49.5 mm), non-paroxysmal AF and both larger LA and non-paroxysmal AF were 30% (12/40), 15.2% (17/112) and 39.1% (9/23), respectively.ConclusionEnlarged LA (anteroposterior diameter ≥49.5 mm) and non-paroxysmal AF were independent risk factors of LAAT in non-valvular AF patients.

Highlights

Atrial fibrillation (AF) is the most common sustained arrhythmia with a prevalence of approximately 3% in adults [1,2], accounting for one-third of hospitalizations for cardiac rhythm disorders [3]
Studies revealed that 90% of left atrial thrombi originate from left atrial appendage (LAA) [6], and thrombus of LAA was associated with its structure and morphology [7]
There were no significant differences in gender, age, smoking, drinking, history of diseases, values of platelets, prothrombin time (PT), activated partial thromboplastin time (APTT), serum creatinine, left ventricular end diastolic dimension (LVEDD) and left ventricular ejection fraction (LVEF) between the two groups

Summary

Introduction

Atrial fibrillation (AF) is the most common sustained arrhythmia with a prevalence of approximately 3% in adults [1,2], accounting for one-third of hospitalizations for cardiac rhythm disorders [3]. AF is independently associated with increased risks of mortality and morbidity, partly due to increased risk of stroke caused by the arrhythmia [4,5]. AF-related ischemic stroke is the result of detachment of left atrial thrombus. Studies revealed that 90% of left atrial thrombi originate from left atrial appendage (LAA) [6], and thrombus of LAA was associated with its structure and morphology [7]. In spite of the anatomical factors of LAA, other risk factors associated with left atrial appendage thrombus (LAAT) were rarely reported. Detection and intervention of LAAT-related risk factors are important for reducing the incidence of thromboembolism in AF patients. We collected and analyzed the clinical data of patients with non-valvular AF who underwent transesophageal echocardiography (TEE) to explore the potential risk factors of LAAT

Methods

Results

Conclusion