Prevalence of Left Atrial Thrombus in Anticoagulated Patients With Atrial Fibrillation

Lurie, Antony; Wang, Jia; Hinnegan, Kyra J.; McIntyre, William F.; Belley‐Côté, Emilie P.; Amit, Guy; Healey, Jeff S.; Connolly, Stuart J.; Wong, Jorge

doi:10.1016/j.jacc.2021.04.036

Cited by 63 publications

(52 citation statements)

References 61 publications

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“…Moreover, in this study, six (12%) patients with anticoagulation for more than 3 weeks were still detected with LAA thrombus. This is consistent with a recent meta-analysis that revealed a nonnegligible prevalence of LA thrombus, even in well-anticoagulated patients with AF, in which a mean-weighted prevalence of 2.73% (95% CI: 1.95-3.80%) among 14,653 patients was reported [36]. This indicates the necessity of performing TEE before cardioversion or catheter ablation, even in patients with lowintermediate risk for stroke before TEE, or those who have received anticoagulant therapy for more than 3 weeks.…”

Section: Discussionsupporting

confidence: 92%

Left Atrial Appendage Thrombus in Patients with Nonvalvular Atrial Fibrillation before Catheter Ablation and Cardioversion: Risk Factors beyond the CHA2DS2-VASc Score

Cai

Xiong

Chen

et al. 2022

JCDD

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Left atrial appendage thrombus (LAAT) is a surrogate of thromboembolic events in patients with nonvalvular atrial fibrillation (NVAF). We aimed to investigate the risk factors for LAAT formation before catheter ablation and cardioversion beside the CHA2DS2-VASc score. In this case-control study, patients with NVAF who underwent transesophageal echocardiography (TEE) were included. Demographic data, laboratory results, and echocardiographic measurements were retrospectively collected. Logistic regression analysis was performed to determine risk factors predicting LAAT. Of the 543 included patients, LAAT was identified in 50 patients (9.2%). Multivariable logistic regression analysis for the entire cohort showed that NT-proBNP (per 500 ng/L increase, OR (95% CI): 1.09 (1.00–1.19), p = 0.038) and LDL-C (per 1 mmol/L increase, OR (95% CI): 1.70 (1.05–2.77), p = 0.032) were independently correlated with the presence of LAAT after the adjustment for CHA2DS2-VASc score and anticoagulant therapy. The subgroup analysis of patients without anticoagulant therapy also yielded similar results. Regarding patients with CHA2DS2-VASc scores ≤ 1, a higher level of LDL-C (per 1 mmol/L increase, OR (95% CI): 6.31 (2.38–16.74), p < 0.001) independently correlated with the presence of LAAT. The present study suggests that beyond CHA2DS2-VASc score, raised NT-proBNP and LDL-C are additional predictors for LAAT in NVAF patients.

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Section: Discussionsupporting

confidence: 92%

Left Atrial Appendage Thrombus in Patients with Nonvalvular Atrial Fibrillation before Catheter Ablation and Cardioversion: Risk Factors beyond the CHA2DS2-VASc Score

Cai

Xiong

Chen

et al. 2022

JCDD

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“…The prevalence of LAT in our population was somewhat higher compared to other studies [ 1 , 8 ]. The reason could be common VKA administration with low time in therapeutic range (TTR), patient non-compliance with therapy, a high share of patients without any antithrombotic therapy or simply higher thromboembolic risk.…”

Section: Discussioncontrasting

confidence: 82%

“…Transesophageal echocardiography (TOE) is often used to exclude left atrial thrombosis (LAT) in patients with atrial fibrillation (AF) undergoing cardioversion or pulmonary vein isolation (PVI). There are multiple reports of LAT in those patients despite anticoagulation therapy which poses a threat of cardioembolism [ 1 ]. Current guidelines do not recommend routine use of TOE in anticoagulated patients [ 2 , 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Left Ventricular Ejection Fraction Can Predict Atrial Thrombosis Even in Non-High-Risk Individuals with Atrial Fibrillation

Angebrandt

Šmalcelj

Kos³

et al. 2022

JCM

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Background—Current guidelines do not recommend routine use of transesophageal echocardiography (TOE) in anticoagulated patients with atrial fibrillation (AF). The aim of our study was to identify predictors for left atrial thrombosis (LAT) in patients with AF that would require TOE despite anticoagulation therapy, using clinical, laboratory and echocardiographic data which are usually obtained in those patients in a real-world setting. Methods—We analyzed data from electronic medical records (EMR) of consecutive AF patients referred to two university hospitals between January 2014 and December 2017 for pulmonary vein isolation (PVI) or direct current cardioversion. The primary endpoint was the presence of left atrial thrombus on TOE. Multivariable and univariable logistic regression models were computed using variables that were significantly different between the LAT and the control groups. Results—A total of 838 patients were included, of whom 132 (15.8%) had LAT. After controlling for other variables, only the left ventricle ejection fraction (LVEF) remained statistically significant with an OR of 0.956 (95% CI 0.934–0.979), p < 0.01. Regression models including LVEF had significantly higher areas under the receiver operating characteristic (ROC) curves, including in subgroups with non-high thromboembolic risk (CHA2DS2-Vasc = 0 or 1), with an area under the curve (AUC) of 0.76 (95% CI 0.71–0.81), p < 0.0001. Conclusions—The LVEF is an independent predictor of LAT, and it might improve thromboembolic risk stratification in future models. LVEF significantly increased the predictive value of the CHA2DS2-Vasc model and was able to identify LAT in non-high-risk patients.

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“…Several reports have described the prevalence and characteristics of LAT in North America and Europe, and approximately 5–27% of AF patients without anticoagulation therapy ( 5 ). Even in anticoagulated patients with AF, LAT cannot be ignored due to the high incidence ( 6 , 7 ), with a pooled prevalence of 2.73% in whom continuously anticoagulated for at least 3 weeks ( 8 ). However, few reports are available about the LAT prevalence in AF patients based on multicenter and large-sample research in China.…”

Section: Introductionmentioning

confidence: 99%

Left Atrial Thrombus in Patients With Non-valvular Atrial Fibrillation: A Cross-Sectional Study in China

Shu

Zhao

Liu

et al. 2022

Front. Cardiovasc. Med.

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BackgroundStroke is predominately attributed to left atrial thrombus (LAT) in patients with non-valvular atrial fibrillation (NVAF), however, its detection rate in real clinical practice has been few reported in China.ObjectiveThis study aimed to investigate the prevalence and associated factors of LAT in patients with NVAF in China.MethodsAll adult NVAF patients undergoing transesophageal echocardiography (TEE) in the China Atrial Fibrillation Center database from January 2017 to January 2022 were enrolled in this study. The prevalence of LAT was calculated, and associated factors were identified.ResultsA total of 36,007 NVAF inpatients from 602 hospitals in 30 provinces/autonomous regions/municipalities were included in the final analysis, with a median age of 66 years and 39.4% were female. LAT was present in 1,467 (4.1%) patients overall, 2.7, 5.7, and 6.8% in patients with paroxysmal, persistent, and long-standing persistent AF, respectively. In subgroup analysis, including age ≥ 65 years, CHA2DS2-VASC score ≥ 2, left atrial diameter (LAD) ≥ 50 mm, left ventricular ejection fraction (LVEF) < 50%, and anticoagulation, patients with paroxysmal AF always had the lowest LAT prevalence, followed by patients with persistent and long-standing persistent AF. Patients treated with anticoagulants had less prevalent LAT than those without anticoagulation (2.1 vs. 5.0%, p < 0.001). In multivariate analysis, AF pattern (both persistent AF and long-standing persistent AF), hypertension, chronic heart failure, coronary heart disease, transient ischemic attack/stroke, diabetes mellitus, and LAD (per 5 mm) were associated with an increased prevalence of LAT. However, LVEF (per 5%) and anticoagulation were associated with a reduced prevalence of LAT.ConclusionLAT was found in 4.1% of Chinese adult NVAF inpatients underwent TEE in real-world experience. The prevalence of LAT mainly associated with non-paroxysmal AF, cardiovascular diseases, diabetes mellitus, enlarged left atrium, lower LVEF, and lack of anticoagulation therapy.

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Prevalence of Left Atrial Thrombus in Anticoagulated Patients With Atrial Fibrillation

Cited by 63 publications

References 61 publications

Left Atrial Appendage Thrombus in Patients with Nonvalvular Atrial Fibrillation before Catheter Ablation and Cardioversion: Risk Factors beyond the CHA2DS2-VASc Score

Left Atrial Appendage Thrombus in Patients with Nonvalvular Atrial Fibrillation before Catheter Ablation and Cardioversion: Risk Factors beyond the CHA2DS2-VASc Score

Left Ventricular Ejection Fraction Can Predict Atrial Thrombosis Even in Non-High-Risk Individuals with Atrial Fibrillation

Left Atrial Thrombus in Patients With Non-valvular Atrial Fibrillation: A Cross-Sectional Study in China

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