Frontiers in Cardiovascular Medicine (Nov 2022)

Echocardiographic predictors of thrombus in left atrial appendage—The role of novel transthoracic parameters

  • Damian Kaufmann,
  • Elżbieta Wabich,
  • Agnieszka Kapłon-Cieślicka,
  • Agnieszka Kapłon-Cieślicka,
  • Monika Gawałko,
  • Monika Gawałko,
  • Monika Gawałko,
  • Monika Gawałko,
  • Monika Budnik,
  • Monika Budnik,
  • Beata Uziębło-Życzkowska,
  • Paweł Krzesiński,
  • Paweł Krzesiński,
  • Katarzyna Starzyk,
  • Beata Wożakowska-Kapłon,
  • Maciej Wójcik,
  • Robert Błaszczyk,
  • Jarosław Hiczkiewicz,
  • Jarosław Hiczkiewicz,
  • Jan Budzianowski,
  • Jan Budzianowski,
  • Katarzyna Mizia-Stec,
  • Katarzyna Mizia-Stec,
  • Maciej T. Wybraniec,
  • Maciej T. Wybraniec,
  • Katarzyna Kosmalska,
  • Marcin Fijałkowski,
  • Marcin Fijałkowski,
  • Anna Szymańska,
  • Anna Szymańska,
  • Mirosław Dłużniewski,
  • Maciej Haberka,
  • Maciej Haberka,
  • Michał Kucio,
  • Błażej Michalski,
  • Błażej Michalski,
  • Karolina Kupczyńska,
  • Karolina Kupczyńska,
  • Anna Tomaszuk-Kazberuk,
  • Anna Tomaszuk-Kazberuk,
  • Katarzyna Wilk-Śledziewska,
  • Katarzyna Wilk-Śledziewska,
  • Renata Wachnicka-Truty,
  • Marek Koziński,
  • Marek Koziński,
  • Paweł Burchardt,
  • Paweł Burchardt,
  • Ludmiła Daniłowicz-Szymanowicz

DOI
https://doi.org/10.3389/fcvm.2022.1059111
Journal volume & issue
Vol. 9

Abstract

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IntroductionThe left atrium appendage thrombus (LAAT) formation is a complex process. A CHA2DS2-VASc scale is an established tool for determining the thromboembolic risk and initiation of anticoagulation treatment in patients with atrial fibrillation or flutter (AF/AFL). We aimed to identify whether any transthoracic echocardiography (TTE) parameters could have an additional impact on LAAT detection.MethodsThat is a sub-study of multicenter, prospective, observational study LATTEE (NCT03591627), which enrolled 3,109 consecutive patients with AF/AFL referred for transesophageal echocardiography (TEE) before cardioversion or ablation.ResultsLAAT was diagnosed in 8.0% of patients. The univariate logistic regression analysis [based on pre-specified in the receiver operating characteristic (ROC) analysis cut-off values with AUC ≥ 0.7] identified left ventricular ejection fraction (LVEF) ≤ 48% and novel TTE parameters i.e., the ratios of LVEF and left atrial diameter (LAD) ≤ 1.1 (AUC 0.75; OR 5.64; 95% CI 4.03–7.9; p < 0.001), LVEF to left atrial area (LAA) ≤ 1.7 (AUC 0.75; OR 5.64; 95% CI 4.02–7.9; p < 0.001), and LVEF to indexed left atrial volume (LAVI) ≤ 1.1 (AUC 0.75, OR 6.77; 95% CI 4.25–10.8; p < 0.001) as significant predictors of LAAT. In a multivariate logistic regression analysis, LVEF/LAVI and LVEF/LAA maintained statistical significance. Calculating the accuracy of the abovementioned ratios according to the CHA2DS2-VASc scale values revealed their highest predictive power for LAAT in a setting with low thromboembolic risk.ConclusionNovel TTE indices could help identify patients with increased probability of the LAAT, with particular applicability for patients at low thromboembolic risk.

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