Spontaneous Echo Contrast In Patients Research Articles

The incremental value of interatrial septum motion in predicting thrombus or spontaneous echo contrast in patients with non-valvular atrial fibrillation: an observational study on transesophageal echocardiography.

The thickness and motion of the Interatrial Septum (IAS) possibly serves as indicators of both structural and functional remodeling of left atrium. This study aims to use transesophageal echocardiography (TEE) to assess IAS motion in non-valvular atrial fibrillation (NVAF) and investigate its correlation with the risk of spontaneous echo contrast (SEC) and thrombus (TH). We conducted a cross-sectional study on 318 patients with NVAF who underwent transthoracic echocardiography and TEE. IAS motion was defined as the maximum displacement of IAS observed throughout the cardiac cycles using M-mode TEE. The prevalence of SEC/TH was 39.9% (127/318) in the overall group. In paroxysmal atrial fibrillation (PAF), the prevalence rate of SEC/TH was 25.3% (47/186), compared to 60.6% (80/132) in persistent atrial fibrillation (PeAF). Multivariable analyses showed that LA volume index (LAVI), mean E/e', S/D ratio, IAS motion and CHA2DS2-VASc scores were significantly associated with SEC/TH. Patients with lower IAS motion showed a higher prevalence of SEC/TH compared to those with higher IAS motion (71.3% vs. 11.6%; P < 0.001). The IAS motion under sinus rhythm could better predict risk of SEC/TH, while the predictive efficacy under AF rhythm was slightly attenuated but still had a high AUC value (0.779). A significant positive correlation was observed between the IAS motion and the LAA filling velocity (PAF r = 0.47; P<0.001 and PeAF r = 0.38; P < 0.001, respectively), LAA emptying velocity (PAF r = 0.55; P < 0.001 and PeAF r = 0.47; P < 0.001, respectively) and LAVI (PAF r = 0.59; P < 0.001 and PeAF r = 0.44; P < 0.001, respectively). The integration of the IAS motion to the CHA2DS2-VASc, LAVI and mean E/e' provided important incremental predictive value of SEC/TH (AUC = 0.859 vs. 0.826, P = 0.02). IAS motion measured by TEE correlates well with LAA flow velocity and LA size and is independently associated with SEC/TH in NVAF. Additionally, lower IAS motion is associated with a higher prevalence of SEC/TH. Furthermore, the integration of IAS motion to CHA2DS2-VASc, LAVI and mean E/e' can provide additional value for the prediction of SEC/TH.

Relationship of inflammatory indices with left atrial appendage thrombus or spontaneous echo contrast in patients with atrial fibrillation.

Inflammatory indices derived from complete blood tests have been reported to be associated with poor outcomes in patients with atrial fibrillation (AF). The data about the relationship between inflammatory indices and left atrial appendage thrombus (LAAT) or dense spontaneous echo contrast (SEC) are limited. To explore the value of inflammatory indices for predicting the presence of LAAT or dense SEC in nonvalvular AF patients. A total of 406 patients with nonvalvular AF who underwent transesophageal echocardiography were included and divided into two groups based on the presence (study group) or absence (control group) of LAAT or dense SEC. Inflammatory indices, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR), were calculated from complete blood analysis. The associations of inflammatory indices with LAAT/dense SEC were analyzed using logistic regression. LAAT and dense SEC were detected in 11 (2.7%) and 42 (10.3%) patients, respectively. The PLR only showed an association with LAAT/dense SEC in the univariate model. Elevated NLR (odds ratio [OR] = 1.48, 95% confidence interval [CI]: 1.11-1.98, P = 0.007) and reduced LMR (OR = 0.59, 95%CI: 0.41-0.83, P = 0.003) were found to be independent risk factors for the presence of LAAT/dense SEC. The areas under the NLR and LMR curves for predicting LAAT/dense SEC were 0.73 (95%CI: 0.66-0.80, P < 0.001) and 0.73 (95%CI: 0.65-0.81, P < 0.001), respectively, while the cutoff values were 2.8 (sensitivity: 69.8%; specificity: 64.0%) and 2.4 (sensitivity: 71.7%; specificity: 60.6%), respectively. Increased NLR and decreased LMR may predict LAAT/dense SEC in patients with nonvalvular AF.

Prevalence of left atrial appendage thrombus and spontaneous echo contrast on transesophageal echocardiography in patients scheduled for pulmonary vein isolation.

To avoid causing a thromboembolic event in patients undergoing catheter ablation for atrial fibrillation (AF), patients are treated with oral anticoagulants (OAC) prior to the procedure. Despite being on anticoagulants, some patients develop a left atrial appendage thrombus (LAAT). To exclude the presence of LAAT, transesophageal ultrasound (TEE) is performed in all patients prior to the procedure. We hypothesized continuous treatment with anticoagulants would result in a low prevalence of LAAT, in patients with low CHA2DS2-VASc score. Medical records of consecutive patients planned to undergo AF ablation at Lund University Hospital during the years 2018-2020 were reviewed retrospectively. Examination protocols from transesophageal and transthoracic echocardiography were examined for LAAT and spontaneous echo contrast (SEC). Patients with LAAT and SEC were compared to patients without using Mann-Whitney U-test and Pearson Chi-squared analysis to test for correlation. Of 553 patients, three patients (0.54%) had LAAT, and 18 (3.25%) had spontaneous contrast (SEC). Patients with LAAT or SEC had a higher CHA2DS2-VASc score, more often presented in AF at TEE and less often had a normal sized left atrium. There is a low prevalence of LAAT and SEC in patients with AF scheduled for pulmonary vein isolation. Patients with SEC or LAAT tend to have paroxysmal AF less often and more often presented in AF at admission. No patients with CHA2DS2-VASc 0, paroxysmal AF, normal sized left atrium and sinus rhythm at TEE were found to have LAAT or SEC.

Clinical significance of aortic spontaneous echo contrast in patients with nonvalvular atrial fibrillation.

Little is known about spontaneous echo contrast (SEC) in the descending aorta (DASEC), occurring with or without SEC in the left atrium (LASEC), in the presence of atrial fibrillation (AF). We examined the clinical significance of DASEC, including its relationship with LASEC, in patients with nonvalvular AF. Among 176 patients, 41 (23%) had DASEC and 51 (29%) had LASEC. The patients were divided into four groups based on the presence/absence of LASEC and DASEC, as Group A: no SEC (n=107); Group B: only LASEC (n=28); Group C: only DASEC (n=18); and Group D: both types of SEC (n=23). Clinical and echocardiographic parameters were compared between groups, and the possible determinants of DASEC were evaluated. Age, sex, and CHA2 DS2 -VASc score were similar in the four groups. Group D was more likely to have an increased LA diameter, decreased left ventricular ejection fraction (LVEF), and low LA appendage velocity compared to Group A. Group C had a smaller LA diameter and a higher appendage velocity than Group B. Multivariate logistic regression analysis, with age ≥75 years, female sex, LASEC, LVEF<50%, and presence of DA plaques included as covariates, showed that LASEC (OR 4.22, 95% CI 1.92-9.26, p<.001) and LVEF<50% (OR 2.70, 95% CI 1.12-6.52, p=.027) were significant determinants of DASEC. The prevalence of DASEC increased with increasing LASEC severity in order of none (13%), mild (28%), and dense (50%) (p<.001). In nonvalvular AF patients, DASEC is common, and it partly originates from LASEC, particularly in the presence of LV systolic dysfunction.

External validation and comparison of CHA2DS2-VASc-RAF and CHA2DS2-VASc-LAF scores for predicting left atrial thrombus and spontaneous echo contrast in patients with non-valvular atrial fibrillation.

CHA2DS2-VASc-RAF (R is renal dysfunction, and AF is atrial fibrillation type) and CHA2DS2-VASc-LAF (L is left atrial diameter, and AF is atrial fibrillation type) scores have been developed to estimate the risk of left atrial thrombus (LAT) and spontaneous echo contrast (SEC) in patients with non-valvular atrial fibrillation (NVAF). However, few external validations have been conducted to assess their accuracy. Thus, this study aimed to validate and compare the two modified scores for predicting LAT/SEC in patients with NVAF. This study included 399 patients with NVAF who underwent transesophageal echocardiography. Risk factors related to LAT/SEC were identified through logistic regression analysis, and predictive value and diagnostic efficiency were evaluated using receiver operating characteristic (ROC) curve. Approximately 9.8% (39/399) of the patients with NVAF had LAT/SEC. Multivariate logistic regression analysis showed that history of stroke/transient ischemic attack, congestive heart failure, non-paroxysmal atrial fibrillation, lack of anticoagulation therapy, enlarged leftatrialdiameter, enlarged left ventricular end diastolic diameter, decreased left ventricular ejection fraction, decreased left atrial appendage emptying velocity, and decreased estimated glomerular filtration rate were independent risk factors for LAT/SEC. The CHA2DS2-VASc-LAF (area under the ROC curve [AUC] = 0.839) and CHA2DS2-VASc-RAF (AUC = 0.829) scores showed larger predictive values than the CHA2DS2-VASc (AUC = 0.737) and CHADS2 (AUC = 0.736) scores. The AUC of the CHA2DS2-VASc-RAF score was similar to that of the CHA2DS2-VASc-LAF score (Z = 0.432; P = 0.666). This study validated that the CHA2DS2-VASc-RAF and CHA2DS2-VASc-LAF scores are useful prognostic scoring systems for predicting LAT/SEC in patients with NVAF.

The Comparison of the Diagnostic Value of Left Atrial Pulmonary Vein Single-Phase and Dual-Phase Enhanced CT Scanning for Left Atrial Appendage Thrombosis and SEC in Patients with Atrial Fibrillation.

Objective The accuracy of left atrial pulmonary vein CT enhanced single-phase and dual-phase scanning in the detection of left atrial appendage (LAA) thrombosis and spontaneous echo contrast (SEC) before radio frequency ablation was compared in atrial fibrillation patients, so as to optimize the scanning scheme. Methods 78 patients with atrial fibrillation who were admitted to Cangzhou Central Hospital from October 2020 to September 2021 and underwent bilateral enhanced CT scan of left atrial pulmonary vein and transesophageal echocardiography (TEE) examination for planned frequency ablation were selected. TEE results were used as the “gold standard” to compare the diagnostic efficacy of the first phase, second phase, and double-phase comprehensive mode of enhanced left atrial pulmonary vein CT in detecting left atrial thrombosis and SEC. Results The sensitivity, specificity, positive predictive value, and negative predictive value were 88.9%, 84.1%, 42.1%, and 98.3%, respectively, in the detection of left atrial thrombosis and SEC by the first phase of CT enhanced scan. The sensitivity, specificity, positive predictive value, and negative predictive value were 22.2%, 98.6%, 66.6%, and 90.7%, respectively, in the detection of left atrial thrombosis and SEC by the second phase of CT enhanced scan. The sensitivity, specificity, positive predictive value, and negative predictive value were 88.9%, 84.1%, 42.1%, and 98.3%, respectively, in the detection of left atrial thrombosis and SEC by the double-phase comprehensive mode of CT enhanced scan. There was no statistically significant difference in the accuracy of CT diagnosis of left atrial appendage thrombosis and SEC between the three modes of the first phase, the second phase, and the double-phase comprehensive CT (P > 0.05). The mean effective radiation dose of double-phase enhanced scan was 7.49 ± 1.02 mSv. Conclusion Single-phase enhanced CT scan of left atrial pulmonary vein can meet clinical requirements and significantly reduce the radiation dose compared with double-phase enhanced CT scan. Therefore, it is recommended as an initial screening examination for patients with atrial fibrillation before radiofrequency ablation.

The Prognostic Nutritional Index May Predict Left Atrial Appendage Thrombus or Dense Spontaneous Echo Contrast in Patients With Atrial Fibrillation.

ObjectivesThe prognostic nutritional index (PNI) is an independent predictor of adverse outcomes in patients with cardiovascular diseases. The presence of left atrial appendage thrombus (LAAT) or spontaneous echo contrast (SEC) is associated with ischemic stroke. The present study aimed to investigate the relationship between the PNI and LAAT/dense SEC in patients with non-valvular atrial fibrillation (AF).MethodsIn patients with non-valvular AF, we compared demographics, clinical characteristics, and prevalence of LAAT/dense SEC according to the levels of the PNI. The relationship between the PNI and LAAT/dense SEC was observed.ResultsA total of 406 patients with non-valvular AF were consecutively included from March 2015 to February 2019. Of the study population, 53 patients had LAAT/dense SEC. The percentages of LAAT/dense SEC were 20.4, 14.1, and 4.5% in subjects from the lowest to the highest tertile of the PNI, respectively. Multivariate logistic analysis demonstrated that the PNI was an independent predictor for LAAT/dense SEC (OR 0.89; 95% CI, 0.82–0.97; P = 0.007). Receiver operating characteristic curve analysis revealed that the optimal cutoff value of the PNI for predicting LAAT/dense SEC was 48.0 (area under the curve: 0.68; 95% CI, 0.61–0.75; P < 0.001). The sensitivity and specificity were 83.0 and 47.6%, respectively. The risk of LAAT/dense SEC in patients with a PNI ≤ 48.0 was 2.57-fold higher than that in those with a PNI > 48.0.ConclusionThe PNI, calculated based on serum albumin and lymphocyte count, was inversely correlated with LAAT/dense SEC in patients with non-valvular AF. Therefore, it may be considered a predictor for LAAT/dense SEC.

Association between interleukin 17A levels and left atrial spontaneous echo contrast in patients with nonvalvular atrial fibrillation.

Association between interleukin 17A levels and left atrial spontaneous echo contrast in patients with nonvalvular atrial fibrillation.

Nomogram to Predict Left Atrial Thrombus or Spontaneous Echo Contrast in Patients With Non-valvular Atrial Fibrillation.

Background: The predictive power of the CHADS2 and CHA2DS2-VASc scores for the presence of Left atrial thrombus (LAT)/ spontaneous echo contrast (SEC) in non-valvular atrial fibrillation (NVAF) is modest. The aim of this analysis is to define clinical and ultrasonic variables associated with LAT/SEC and to propose nomograms for individual risk prediction.Methods: Data on 1,813 consecutive NVAF patients who underwent transesophageal echocardiography (TEE) from January 2016 to January 2021 were collected. The univariate and multivariate logistic regression analyses were used to construct a nomogram. We examined the predictive ability of the risk scores by calculating the area under the curve (AUC). Moreover, the performance of the nomogram was assessed with respect to calibration, discrimination, and clinical usefulness.Results: LAT/SEC was found in 260 (21.0%) and 124 (21.6%) patients in the training and validation cohorts, respectively. On multivariate analysis, independent factors for LAT/SEC were Age, left atrial diameter (LAD), left ventricular ejection fraction (LVEF), hypertension (HTN), previous stroke or transient ischemic attack, Non-paroxysmal AF and a nomogram was built based on these variables. The calibration curve for the probability of LAT/SEC showed good prediction agreement with actual observation. The nomogram achieved good concordance indexes of 0.836 and 0.794 in predicting LAT/SEC in the training and validation cohorts, respectively. Decision curve analysis demonstrated that the nomogram would be clinically useful.Conclusions: In this study, a nomogram was constructed that incorporated six characteristics of NVAF patients. The nomogram may be of great value for the prediction of LAT/SEC in NVAF patients.

Presence of Spontaneous Echo Contrast on Point-of-Care Vascular Ultrasound and the Development of Major Clotting Events in Coronavirus Disease 2019 Patients.

This was a retrospective cohort study of 39 adult patients admitted to the ICU with a confirmed coronavirus disease 2019 diagnosis at a large tertiary-care academic medical center. Patients were included if they had undergone a vascular ultrasound examination during their ICU admission. Overall, 48 venous ultrasound studies among the 39 patients were reviewed in blinded fashion by two reviewers for the presence of venous spontaneous echo contrast, and charts were analyzed for laboratory data and outcomes. pontaneous echo contrast correlated with serum viscosity (mean values of 2.64, 2.54, and 2.04 cP for dense spontaneous echo contrast, spontaneous echo contrast , and no spontaneous echo contrast, respectively, with a p value of 0.0056 for spontaneous echo contrast compared with negative spontaneous echo contrast) and hyperfibrinogenemia (mean values of 726.6, 668.5, and 566.6 mg/dL for dense spontaneous echo contrast, positive spontaneous echo contrast, and negative spontaneous echo contrast, respectively, with a p value of 0.0045 for dense spontaneous echo contrast compared with negative spontaneous echo contrast). About 36% of patients with dense spontaneous echo contrast and 33% of individuals with positive spontaneous echo contrast experienced significant clotting events compared with 17% of those with negative spontaneous echo contrast. A total of 19% of patients with spontaneous echo contrast suffered a cardiac arrest following a major clotting event, and there were no cardiac arrests from clotting events in the negative spontaneous echo contrast group. There was no association with the presence of spontaneous echo contrast and right or left cardiac function or other laboratory values such as d-dimer, external thromboelastometry - maximum lysis, platelet counts, C-reactive protein, or interleukin-6. Point-of-care venous ultrasonography is easily performed and reliably interpreted for visualization of spontaneous echo contrast. The presence of spontaneous echo contrast in patients with coronavirus disease 2019 is associated with hyperviscosity and increased rates of thrombotic events and complications.

CHA2DS2-VASc Score as a Predictor for Left Atrial Thrombus or Spontaneous Echo Contrast in Patients with Nonvalvular Atrial Fibrillation: A Meta-Analysis

Objective This meta-analysis aimed at exploring the predictive value of CHA2DS2-VASc score for the left atrial thrombus (LAT) or left atrial spontaneous echo contrast (LASEC) in patients with nonvalvular atrial fibrillation (NVAF). Methods PubMed, Embase, Web of Science, ScienceDirect, Cochrane Library, and Chinese core journals of the CNKI and Wanfang databases were searched to identify all the relevant papers that were published up to January 2020. The data were extracted for pooled odds ratios (ORs) with 95% confidence intervals (CIs), heterogeneity, subgroup, publication bias, and sensitivity analysis. Results Overall, 15 studies containing 6223 patients with NVAF were enrolled. All studies were evaluated for LAT, and 12 studies were evaluated for LASEC. The pooled analysis using a random-effects model showed that a high CHA2DS2-VASc score was related with LAT/LASEC (pooled OR = 1.59, 95% CI: 1.35–1.88, P < 0.001) with high heterogeneity (I2 = 76.9%, P < 0.001) and LAT (pooled OR = 1.83, 95% CI: 1.44–2.33, P < 0.001) with high heterogeneity (I2 = 79.4%, P < 0.001). The subgroup analysis demonstrated that the sample size may be the main source of heterogeneity. Although the Begg's funnel plot based on 15 studies for LAT/LASEC (P = 0.029) and 12 studies for LAT (P = 0.046) indicated the presence of publication bias among the included studies, the trim-and-fill method verified the stability of the pooled outcomes. In addition, sensitivity analysis indicated that all effects were stable. Conclusion The results of this meta-analysis showed that the CHA2DS2-VASc score is related with LAT and LASEC in patients with NVAF. However, more studies are warranted to address this issue.

A new risk model for the evaluation of the thromboembolic milieu in patients with atrial fibrillation: the PALSE score.

The evaluation of thromboembolic risk is the cornerstone of atrial fibrillation (AF) management. Thromboembolic risk is associated with the presence of left atrial (LA) thrombus and spontaneous echo contrast (SEC), namely the thromboembolic milieu. We aimed to assess the predictors of the thromboembolic milieu in terms of LA thrombus and/ or SEC in patients with paroxysmal AF undergoing electrical cardioversion or catheter ablation, and to develop an effective risk model for detecting the thromboembolic milieu. We included a total of 434 patients with nonvalvular paroxysmal AF who underwent transesophageal echocardiography prior to cardioversion or catheter ablation. In patients with the thromboembolic milieu, total protein and C‑reactive protein levels, LA diameter, and systolic pulmonary artery pressure (SPAP) were higher, while left ventricular ejection fraction (LVEF) was lower than in patients without the thromboembolic milieu. In a multivariate logistic regression analysis, age, total protein levels, LVEF, LA diameter, and SPAP were independent predictors of LA thrombus and/or SEC. In a receiver operating characteristic curve analysis, the optimal cutoff values for the discrimination of patients with the thromboembolic milieu were as follows: 60 years for age; 7.3 mg/dl for total protein; 40% for LVEF; 40 mm for LA diameter; and 35 mm Hg for SPAP. Based on these cutoff values, we developed a novel risk model, namely, the PALSE score. The area under the curve for the PALSE score was 0.833. Patients with a PALSE score lower than 1 did not show thrombus or spontaneous echo contrast. The PALSE score, which includes total protein levels, age, LA diameter, SPAP, and LVEF, seemed to accurately predict the presence of the thromboembolic milieu in patients with paroxysmal AF.

370 Left Atrial Thrombus and Dense Spontaneous Echo Contrast Among Patients on Apixaban, Dabigatran, and Rivaroxaban

Despite optimisation of oral anticoagulation, left atrial (LA) thrombus is often detected among patients with atrial fibrillation (AF) or flutter (AFL) undergoing transoesophageal echocardiography (TOE). Our aim was to evaluate the prevalence of LA thrombus and SEC in patients with AF or AFL undergoing Apixaban, Dabigatran, or Rivaroxaban therapy. Single-centre, retrospective analysis of all patients who underwent TOE prior to direct-current cardioversion for AF or AFL, between 1st January 2011 and 31st December 2018. All 108 patients (72% male; mean age 64.3±12 years) were on novel oral anticoagulants (NOACs) as follows; 22%(n=24) on Dabigatran, 27%(n=29) on Rivaroxaban and 51%(n=55) on Apixaban. AF patients comprised 83%(n=90) of the study population while 17%(n=18) had AFL. The median BMI was 31(IQR 26-36) and median CHA2DS2-VASc score was 2(IQR 1-3). LA was severely dilated in 16% of all patients. TOE detected LA thrombus in 1.9%(n=2) of patients (located in the LA appendage) and dense spontaneous echo contrast (SEC) in 4.6%(n=5) of patients. SEC was classified according to emptying flow velocities, as per cardiovascular imaging guidelines. LA thrombus and/or dense SEC was prevalent in 5.6%(n=6) of patients (Apixaban 3.6%, Dabigatran 8.3%, and Rivaroxaban 6.9%, p=0.66). Patients with LA thrombus and/or SEC had a median CHA2DS2-VASc score of 3(IQR 2-5). The prevalence of LA thrombus in a cohort of patients anticoagulated with NOACs is low but important. All three NOAC agents are equally effective in preventing LAT and/or SEC. Further larger studies are warranted to confirm this result.

Relationship between presence of spontaneous echo contrast and platelet-to-lymphocyte ratio in patients with mitral stenosis.

Left atrial spontaneous echo contrast (SEC) is an existence of smoke-like echoes with a typical swirling motion of blood in left atrial cavity or appendage, and it is known to be a marker of prothrombotic state. Previous studies have revealed that there is an association between prothrombotic state and the platelet-to-lymphocyte ratio (PLR). Thus, we aimed to investigate the association between the presence of SEC and PLR in patients with mitral stenosis (MS). A total of 306 consecutive patients with MS were enrolled in the study. Transoesophageal echocardiography was made to assess the SEC for all patients. Recruited patients were divided into two groups according to the formation of SEC in the left atrium. Complete blood counting parameters, biochemical tests and high-sensitive C-reactive protein (Hs-CRP) levels were measured. There were 182 patients (mean age 42.7±11.9 and 78% female) in the SEC (-) group, and 124 patients (mean age 45.3±10.5 and 68% female) in the SEC (+) group. Hs-CRP levels (3.9±1.9 vs 5.1±3.6, P<0.001) were significantly different between the two groups. PLR (143.4±77.7 vs 180.6±108.7, P<0.001) was significantly higher in the SEC (+) group. ROC curve analysis, PRL ≥123 had 71% sensitivity and 52% specificity in predicting SEC in patients with MS. Platelet-to-lymphocyte ratio is an inexpensive and easily calculated biomarker, which is useful to predict left atrial SEC in patients with mitral stenosis.

The value of left atrial structural and functional parameters combined with cardiac biomarkers in predicting left atrial spontaneous echo contrast in patients with non-valvular atrial fibrillation

Objective To investigate the relationships between the structure, function of left atrial as well as cardiac biomarkers and left atrial spontaneous echo contrast (SEC) in patients with non-valvular atrial fibrillation (NVAF), and evaluate its predictive value for left atrial SEC. Methods Thirty-four control subjects and 80 patients with NVAF were included, patients with NVAF were divided into positive group (30 cases) and negative group (50 cases) according to whether SEC was presented on transesophageal echocardiography (TEE). Clinical and laboratory data were collected, including medical history, cardiac troponin I (cTnI), and pro-brain natriuretic peptide (pro-BNP), etc. Then CHA2DS2-VASc scores were calculated.The left atrial appendage width (WLAA), left atrial appendage depth (DLAA), left atrial appendage blood flow velocity (VLAA), left atrial volume index (LAVI) and other parameters were measured by TEE and transthoracic echocardiography (TTE), and left atrial ejection fraction (LAEF) was calculated. The clinical and TEE parameters were compared between the positive and negative group, TTE parameters and cardiac biomarkers levels were compared among the three groups, and ROC curve was used to evaluate the diagnostic efficiency. Results ①Compared with those in control group, the value of LAVI and pro-BNP were significantly increased and LAEF was significantly decreased in negative group (all P 0.05), but presented a significant increase in positive group compared with those in control group and negative group (all P<0.01). The AUC, sensitivity and specificity of CHA2DS2-VASc scores for SEC were 0.71 (95% CI: 0.60~0.82), 73.3% and 62.0%, respectively. When left atrial structural and functional parameters (LAVI and LAEF) combined with cardiac biomarkers (cTnI and pro-BNP), the AUC, sensitivity and specificity for SEC were 0.90 (95%CI: 0.84~0.97), 74.0% and 100%, respectively, both enhanced when compared with CHA2DS2-VASc scores alone(P<0.01). Conclusions Left atrial enlargement, decreased function and elevated levels of cardiac biomarkers are associated with left atrial SEC in patients with NVAF.CHA2DS2-VASc scores can be used for perdicting left atrial SEC, left atrial structural and functional parameters (LAVI and LAEF) combined with cardiac biomarkers (cTnI and pro-BNP) provide significant increments in prediction of left atrial SEC. Key words: Echocardiography, transesophageal; Atrial fibrillation; Atrial function, left; Spontaneous echo contrast; Cardiac biomarker

Predictive value of left atrial appendage lobes on left atrial thrombus or spontaneous echo contrast in patients with non-valvular atrial fibrillation

BackgroundLeft atrial appendage morphology has been proved to be an important predictor of left atrial thrombus (LAT) and left atrial spontaneous echo contrast (LASEC) and stroke in patients with non-valvular atrial fibrillation (NVAF). However, the relation between left atrial appendage (LAA) lobes and LAT or LASEC is still unknown. The aim of this study is to investigate the correlation between the number of left atrial appendage lobes and LAT/LASEC in patients with NVAF.MethodsThis monocentric cross-sectional study enrolled 472 consecutive patients with non-valvular atrial fibrillation, who had transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) prior to cardioversion or left atrial appendage closure (LAAC) from July 2009 to August 2015 in department of cardiology of Shanghai Tenth People’s Hospital. Patients who had significant mitral or aortic valve disease, previous cardiac valvular surgery and other complicated cardiac diseases were excluded. Individuals were divided into two groups:the LAT/LASEC group (16.95%), which comprised patients with LAT or LASEC, as confirmed by TEE; and a negative control group (83.05%).Baseline overall group characterization with demographic, clinical, laboratory data and echocardiographic parameters, alongside with information on medication was obtained for all patients. Subgroup analysis with line chart was applied for exploring the association between LAA lobes and LAT/LAESC. Receptor-operating curves (ROC) were used to test the value of LA anteroposterior diameter detected by different echocardiography methods predicting LAT or LASEC. Multivariable logistic regression analysis was used to investigate independent predictors of LAT/LASEC.ResultsAmong 472 patients, 23 (4.87%) had LA/LAA thrombus and 57 (12.1%) had LA spontaneous echo contrast. Compared to the negative group, patients in LAT/LASEC group had higher CHA2DS2-VASc score (3.79 ± 1.75 vs 2.65 ± 1.76, p < 0.001), larger LAD (measured by TTE, 48.1 ± 7.7 vs 44.6 ± 6.5, P < 0.001; measured by TEE, 52.2 ± 6.2 vs 46.7 ± 7.1, P < 0.001), lower left upper pulmonary venous flow velocity (LUPVFV) (0.54 ± 0.17 m/s vs 0.67 ± 0.26 m/s, CI 95% 0.05–0.22, P = 0.003), more left atrial appendage lobes (1.67 ± 0.77 vs 1.25 ± 0.50, p < 0.001). There was a good discriminative capacity for LAD detected by TTE (area under the curve (AUC), 0.67, CI 95% 0.61–0.73, p < 0.001) and LAD detected by TEE (AUC, 0.73, CI 95% 0.67–0.79, p < 0.001). The subgroup analysis based on gender and different LAA lobes yielded similar results (male group: p < 0.001;female group: p = 0.004) that the number of LAA lobes were significantly associated with LA thrombus or SEC. In multivariable logistic regression analysis, both the number of LAA lobes (odds ratio: 2.37; CI 95% 1.37–4.09; p = 0.002) and the persistent AF (odds ratio: 3.57; CI 95% 1.68–7.57; p = 0.001) provided independent and incremental predictive value beyond CHA2DS2-VASc score.ConclusionThe number of LAA lobes is an independent risk factor and has a moderate predictive value for LAT/LASEC among NVAF patients in China.

Predictive value of red cell distribution width on left atrial thrombus or left atrial spontaneous echo contrast in patients with non-valvular atrial fibrillation.

ObjectiveTo evaluate the predictive value of red cell distribution width (RDW) on left atrial thrombus (LAT) or left atrial spontaneous echo contrast (LASEC) in patients with non-valvular atrial fibrillation (AF).MethodsWe reviewed 692 patients who were diagnosed as non-valvular AF and underwent transesophageal echocardiography (TEE) in Guangdong Cardiovascular Institute from April 2014 to December 2015. The baseline clinical characteristics, laboratory test of blood routine, electrocardiograph measurements were analyzed.ResultsEighty-four patients were examined with LAT/LASEC under TEE. The mean RDW level was significantly higher in LAT/LASEC patients compared with the non-LAT/LASEC patients (13.59% ± 1.07% vs. 14.34% ± 1.34%; P < 0.001). Receiver–operating characteristic curve analysis was performed and indicated the best RDW cut point was 13.16%. Furthermore, multivariate logistic regression analysis indicated that RDW level > 13.16% could be an independent risk factor for LAT/LASEC in patients with AF.ConclusionElevated RDW level is associated with the presence of LAT/LASEC and could be with moderate predictive value for LAT/LASEC in patients with non-valvular AF.

P285Prevalence and clinical correlates of spontaneous echo contrast in patients with paroxysmal and persistent atrial fibrillation

P285Prevalence and clinical correlates of spontaneous echo contrast in patients with paroxysmal and persistent atrial fibrillation

Abstract TP178: Thrombi Occluding the Intracranial Artery Are Larger in Stroke Patients With Atrial Fibrillation in the Presence of Spontaneous Echo Contrast

Introduction: Spontaneous echo contrast (SEC) is frequently observed in patients with atrial fibrillation (AF). SEC represents red blood cell aggregates associated with increased thrombogenecity, which may produce larger thrombus formation. This can result in larger infarctions and severe stroke. Hypothesis: Thrombus characteristics occluding the intracranial artery may differ between AF patients with concomitant SEC and those without. Methods: This was a post hoc analysis of prospective cohort. Acute stroke patients with non-valvular AF who underwent transesophageal echocardiography and thin-section (1 or 1.25 mm) noncontrast CT between January 2008 and December 2014 were considered for this study. The volume and the density of thrombus were measured semi-automatically using three-dimensional image software, and compared between the patients with SEC and those without. Results: Among 368 patients considered, thrombus was identified in 135 patients. Of the135 patients, 67 (49.6%) had SEC. The frequency of SEC was not different between patients with identified thrombi and those without (P=0.146). Thrombus volume was larger in the patients with SEC than those without (median [interquartile range], 75.0 mm 3 [46.1-142.9] versus 55.9 mm 3 [30.3-91.8]; P=0.013). As the degree of SEC increased, the thrombus volume increased (P=0.025). On multivariate analysis, the presence of SEC was independently associated with thrombus volume. (P=0.008) . Linear regression analysis showed positive association between initial National Institute of Health Stroke Scale scores and thrombus volume (P&lt;0.001). However, thrombus density was not different between patients with SEC and those without (P=0.226). Conclusions: This study suggests that increased thromogenecity by SEC in patients with AF might produce larger intracardiac thrombi and embolization, which resulted in larger thrombi occluding the intracranial artery and more severe stroke.

Increased levels of red cell distribution width is correlated with presence of left atrial stasis in patients with non-valvular atrial fibrillation.

OBJECTIVE:Red cell distribution width (RDW) and neutrophil to lymphocyte ratio (NLR) have been found to be associated with non-valvular atrial fibrillation (AF) and cardiovascular diseases. However, correlation of these parameters with presence of left atrial (LA) thrombus and/or spontaneous echo contrast (SEC) in patients with non-valvular AF has not been clarified. This study was an investigation of correlation of RDW, NLR, and clinical risk factors with LA thrombus and dense SEC in patients with non-valvular AF in the Turkish population.METHODS:The demographic, laboratory, and echocardiographic properties of 619 non-valvular AF patients who underwent transesophageal echocardiography (TEE) examination before direct current cardioversion (DCCV) or AF ablation treatment were retrospectively investigated. Complete blood count (CBC) and biochemical parameters were studied 6 to 12 hours before TEE examination. Left atrial stasis (LAS) markers were noted as presence of left atrial/left atrial appendage (LA/LAA) thrombus or dense spontaneous echo contrast (DSEC).RESULTS:Total of 325 (52%) patients with LAS were compared with 294 patients (48%) without LAS. In the LAS group, there were 274 (84%) patients with LA/LAA thrombus and 51 (16%) patients with DSEC. LAS (+) group, values for RDW (14.85±1.48 vs. 13.77±1.30; p<0.01), NLR (2.38 [1.58], vs. 2.10 [1.35]; p<0.01) and C-reactive protein (0.95 [0.61] vs. 0.88 [0.60] mg/L; p<0.01) were significantly higher than seen in LAS (-) group. In multivariate regression analysis, increased level of RDW, age, male gender, heart failure, duration of AF >6 months, and international normalized ratio <2 were independently correlated with presence of LAS.CONCLUSION:Our study indicated that increased level of RDW is independently correlated with higher risk for development of LAS in patients with non-valvular AF.