Frontiers in Cardiovascular Medicine (Oct 2022)

Risk factors for left atrial thrombus in younger patients (aged < 65 years) with atrial fibrillation or atrial flutter: Data from the multicenter left atrial thrombus on transesophageal echocardiography (LATTEE) registry

  • Beata Uziȩbło-Życzkowska,
  • Agnieszka Kapłon-Cieślicka,
  • Agnieszka Kapłon-Cieślicka,
  • Monika Gawałko,
  • Monika Gawałko,
  • Monika Gawałko,
  • Monika Gawałko,
  • Monika Budnik,
  • Monika Budnik,
  • Katarzyna Starzyk,
  • Beata Wożakowska-Kapłon,
  • Ludmiła Daniłowicz-Szymanowicz,
  • Damian Kaufmann,
  • Maciej Wójcik,
  • Maciej Wójcik,
  • Robert Błaszczyk,
  • Jarosław Hiczkiewicz,
  • Jarosław Hiczkiewicz,
  • Katarzyna Łojewska,
  • Katarzyna Mizia-Stec,
  • Katarzyna Mizia-Stec,
  • Katarzyna Mizia-Stec,
  • Maciej Wybraniec,
  • Maciej Wybraniec,
  • Maciej Wybraniec,
  • Katarzyna Kosmalska,
  • Marcin Fijałkowski,
  • Anna Szymańska,
  • Aleksandra Gos,
  • Maciej Haberka,
  • Maciej Haberka,
  • Michał Kucio,
  • Błazej Michalski,
  • Błazej Michalski,
  • Karolina Kupczyńska,
  • Karolina Kupczyńska,
  • Anna Tomaszuk-Kazberuk,
  • Katarzyna Wilk-Śledziewska,
  • Renata Wachnicka-Truty,
  • Marek Koziński,
  • Marek Koziński,
  • Paweł Burchardt,
  • Paweł Burchardt,
  • Paweł Krzesiński,
  • Paweł Krzesiński

DOI
https://doi.org/10.3389/fcvm.2022.973043
Journal volume & issue
Vol. 9

Abstract

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BackgroundOur aim was to assess the characteristics and to identify predictors of left atrial thrombus (LAT) in patients under age 65 with atrial fibrillation (AF) or atrial flutter (AFl).MethodsWe conducted a subanalysis of a multicenter, prospective, observational study [the LATTEE registry]. Consecutive AF/AFl patients referred for cardioversion or ablation were enrolled.ResultsOf the 3,109 patients included in the study, 1,276 were under age 65 (41%). Compared to non-LAT patients, those with LAT (n = 76) had higher CHA2DS2-VASc score (p < 0.001), more frequently had non-paroxysmal AF/AFl (p < 0.001), heart failure (p < 0.001), history of diabetes mellitus (p = 0.001), transient ischemic attack (p = 0.04), coronary artery disease (p = 0.02), and chronic kidney disease (p < 0.001). The LAT patients were also more often smokers (p = 0.004) and were more frequently treated with vitamin K antagonists (VKAs) (p < 0.001). Transthoracic echocardiography revealed a higher left atrial area (p < 0.001), lower left ventricular ejection fraction (LVEF) (p < 0.001), and lower value of LA appendage emptying volume in LAT than in non-LAT patients (p < 0.001). LVEF (OR 2.95; 95% CI: 1.32–6.59, p = 0.008), non-paroxysmal AF/AFl (OR 7.1; 95% CI: 2.05–24.63, p = 0.002) and treatment with VKAs (OR 4.92; 95% CI: 2.48–9.75, p < 0.001) were identified as independent predictors of LAT in younger patients.ConclusionsOur study, which focused on younger patients with AF/AFl, indicated substantial clinical and echocardiographic differences between participants with and without LAT. In the AF/AFl patients younger than age 65, the independent predictors of LAT included non-paroxysmal AF/AFl, lower LVEF, and treatment with VKAs.

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