The presence of spontaneous echo contrast didn't increase the risk for left atrial appendage closure: A propensity score matching analysis based on the CLACBAC study
Jun Zhang,
Lili Zhou,
Zhongyuan Ren,
Shiyu Feng,
Jiayu Wu,
Haotian Yang,
Yixing Zheng,
Weilun Meng,
Yang Su,
Jun Xu,
Hui Sun,
Yifan Zhao,
Yun Xie,
Yawei Xu,
Dongdong Zhao
Affiliations
Jun Zhang
Heart Center, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Tongji University School of Medicine, Shanghai, China
Lili Zhou
Heart Center, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Tongji University School of Medicine, Shanghai, China
Zhongyuan Ren
Heart Center, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Tongji University School of Medicine, Shanghai, China
Shiyu Feng
Tongji University School of Medicine, Shanghai, China
Jiayu Wu
Heart Center, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Tongji University School of Medicine, Shanghai, China; Anhui University of Science and Technology, School of Medicine, Huainan, Anhui Province, China
Haotian Yang
Heart Center, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Tongji University School of Medicine, Shanghai, China
Yixing Zheng
Department of Cardiology, Putuo District People's Hospital, School of Medicine, Tongji University, Shanghai, China
Weilun Meng
Heart Center, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Tongji University School of Medicine, Shanghai, China
Yang Su
Heart Center, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
Jun Xu
Heart Center, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
Hui Sun
Heart Center, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Department of Cardiology, Shanghai Tenth People's Hospital Chongming Branch, Shanghai, China
Yifan Zhao
Heart Center, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
Yun Xie
Department of Cardiology, Putuo District People's Hospital, School of Medicine, Tongji University, Shanghai, China; Corresponding author. Department of Cardiology, Putuo District People's Hospital, School of Medicine, Tongji University, Shanghai, 200060, China.
Yawei Xu
Heart Center, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Corresponding author. Heart Center, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
Dongdong Zhao
Heart Center, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China; Corresponding author. Heart Center, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
Background: Left atrial appendage closure (LAAC) was effective in preventing thromboembolic events and stroke in patients with atrial fibrillation (AF). However, whether left atrial spontaneous echo contrast (LA-SEC) poses a higher risk for thromboembolism is contradictory. We aimed to investigate whether LA-SEC is a risk factor for thromboembolic events in patients who underwent LAAC. Methods: 258 consecutive patients who underwent successful LAAC were enrolled and divided according to the presence or absence of LA-SEC detected by transesophageal echocardiography (TEE). Propensity score matching (PSM) was used to eliminate covariate imbalances. Baseline characteristics, periprocedural details, and clinical outcomes were compared between LA-SEC and non-LA-SEC groups and PSM-matched groups. Results: Of the 258 patients enrolled, mean age was 71.8 ± 8.3 years and 59.3 % were male. LA-SEC group had a higher percentage of persistent AF and worse cardiac function. No significant difference in peri-procedure parameters was found. Through follow-up of 38.1 ± 10.7 months, the total incidence of thromboembolic events and stroke was 7.8 % and 6.6 %, respectively. Though the event-free survival rate of thromboembolic events (Log-Rank P = 0.042) and stroke (Log-Rank P = 0.010) was significantly lower in the LA-SEC group, multivariable COX regression analysis showed LA-SEC was not an independent predictor of thromboembolic events (Hazard ratio 2.073, 95 % Confidence interval 0.845–5.082, P = 0.111). Further survival analysis between PSM-matched groups with comparable baseline characteristics presented no significant difference in survival free from thromboembolic events (Log-Rank P = 0.616) and stroke (Log-Rank P = 0.312). Conclusion: Patients with LA-SEC had worse condition, while LA-SEC per se did not increase the incidence of thromboembolic events and stroke for patients who underwent LAAC.
