Predictors of left atrial appendage thrombus despite NOAC use in nonvalvular atrial fibrillation and flutter

Shah, Maulin; Mobaligh, Neigena; Niku, Adam; Shiota, Takahiro; Siegel, Robert J.; Rader, Florian

doi:10.1016/j.ijcard.2020.04.070

Cited by 13 publications

(7 citation statements)

References 18 publications

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“…High CHADS2 and CHA2DS2-VASc scores have been reported to be associated with LAT. 26 In the current study, either CHADS2 or CHA2DS2-VASc score provided an independent but limited predictive value for LAT/SEC. This was consistent with a previous report that the predictive value of CHADS2 or CHA2DS2-VASc for LAT ranged from 0.55 to 0.7.…”

Section: Discussionmentioning

confidence: 48%

Refinement of CHADS2 and CHA2DS2-VASc scores predict left atrial thrombus or spontaneous echo contrast in nonvalvular atrial fibrillation patients

et al. 2022

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Objective To investigate the risk factors of left atrial thrombus (LAT)/spontaneous echo contrast (SEC) in patients with nonvalvular atrial fibrillation (AF). Methods This retrospective study analysed the data from consecutive patients with nonvalvular AF that underwent transoesophageal echocardiography. Logistic regression analysis was performed to identify risk factors of LAT/SEC. Receiver operating characteristic curve analysis was undertaken compare the new scales with CHADS2 and CHA2DS2-VASc scores. Results A total of 558 patients with AF were included in the study. LAT/SEC was detected in 137 (24.6%) patients. The independent risk factors of LAT/SEC beyond CHADS2 or CHA2DS2-VASc scores included non-paroxysmal AF and left atrial diameter >37.5 mm. These two variables were added into the CHADS2 or CHA2DS2-VASc score to build new scales. Areas under the curve for the new scales based on CHADS2 and CHA2DS2-VASc scores were significantly higher than the CHADS2 or CHA2DS2-VASc score both in the overall study cohort and in patients at a high risk of thromboembolism. Conclusions Non-paroxysmal AF and increased left atrial diameter beyond the CHADS2 or CHA2DS2-VASc score were independent risk factors of LAT/SEC and may help to improve the current risk stratification, especially for patients with nonvalvular AF at a high risk of thromboembolism.

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Section: Discussionmentioning

confidence: 48%

Refinement of CHADS2 and CHA2DS2-VASc scores predict left atrial thrombus or spontaneous echo contrast in nonvalvular atrial fibrillation patients

et al. 2022

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“…In our study, women had a smaller LA size, smaller left ventricular diastolic diameter, and higher LVEF than men. Similarly, Shah et al [18] observed that left atrial dilation, absence of severe mitral regurgitation, and lower LVEF are associated with an increased risk of LAAT.…”

Section: Discussionmentioning

confidence: 85%

Differences in the predictors of left atrial appendage thrombus between men and women treated with dabigatran or rivaroxaban

Ciba-Stemplewska¹,

Gorczyca²,

Kapłon‐Cieślicka³

et al. 2022

Polish Archives of Internal Medicine

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The gold standard for the exclusion of left atrial appendage thrombus (LAAT) is transesophageal echocardiography (TOE). There are no unequivocal data on whether patients awaiting ablation or electric cardioversion should routinely undergo TOE, which is an invasive procedure performed by trained and experienced personnel. Some patients with atrial fibrillation (AF) develop LAAT despite receiving anticoagulant treatment. The CHADS2 and CHA2DS2-VASc scores are used to assess thromboembolic risk in patients with nonvalvular AF. The CHA2DS2-VASc-RAF score has been developed to improve thromboembolic risk stratification. In this study, we identified sex-related predictors of LAAT in patients treated with dabigatran or rivaroxaban. All the assessed scores had a similar predictive value in men, while the CHA2DS2-VASc-RAF score had the highest predictive value in women.

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“…Al Rawahi et al 36 found that heart failure and prior stroke could predict the nonresolution of atrial thrombus. Chen et al 37 and Shah et al 38 also noted that a history of ischemic stroke and an enlarged left atrium were associated with the formation of atrial thrombus. In addition, abnormalities in various echocardiographic parameters, such as low LAA emptying velocity (<40 cm/s), high left ventricle (LV) filling pressure, or coexistence of mitral valve disease, might also be predictive of the persistence of atrial thrombus.…”

Section: Discussionmentioning

confidence: 98%

Characteristics, Thrombus Resolution, and Long-Term Outcomes in Patients with Nonvalvular Atrial Fibrillation and Atrial Thrombus

Yang

Zhang

Chen

et al. 2023

Clin Appl Thromb Hemost

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To assess the prevalence and management of atrial thrombus in patients with nonvalvular atrial fibrillation (NVAF) and identify the risk factors of the nonresolution of atrial thrombus. This single-center retrospective observational study consecutively enrolled patients with NVAF and atrial thrombus detected using transesophageal echocardiography (TEE) or cardiac computed tomography angiography (CTA) from January 2012 to December 2020. Patients with prior left atrial appendage (LAA) intervention were excluded. The primary endpoint was the presence of atrial thrombus, while the secondary endpoint was the complete resolution of atrial thrombus. The prevalence of atrial thrombus in patients with NVAF was 1.4%. Ninety patients with atrial thrombus (mean age 62.8 ± 11.9 years and 61.1% men) were finally analyzed. Atrial thrombus was in the LAA in 82 (91.1%) patients. During follow up, 60% of the patients showed complete resolution of atrial thrombus. Congestive heart failure (odds ratio [OR]: 8.94; 95% confidence interval [CI]: 1.67-47.80) and a history of ischemic stroke (OR: 8.28; 95% CI: 1.48-46.42) were independently associated with the risk of the nonresolution of atrial thrombus. The presence of atrial thrombus in patients with NVAF who received anticoagulation therapy is non-negligible. Even in anticoagulated patients, TEE or cardiac CTA might still be needed. Congestive heart failure and a history of ischemic stroke are risk factors of the nonresolution of atrial thrombus.

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Predictors of left atrial appendage thrombus despite NOAC use in nonvalvular atrial fibrillation and flutter

Cited by 13 publications

References 18 publications

Refinement of CHADS2 and CHA2DS2-VASc scores predict left atrial thrombus or spontaneous echo contrast in nonvalvular atrial fibrillation patients

Refinement of CHADS2 and CHA2DS2-VASc scores predict left atrial thrombus or spontaneous echo contrast in nonvalvular atrial fibrillation patients

Differences in the predictors of left atrial appendage thrombus between men and women treated with dabigatran or rivaroxaban

Characteristics, Thrombus Resolution, and Long-Term Outcomes in Patients with Nonvalvular Atrial Fibrillation and Atrial Thrombus

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