Transesophageal echocardiographic thromboembolic risk is associated with smoking status in patients with atrial fibrillation

Abstract

BackgroundSmoking is a risk factor for cardiovascular diseases, but it is unclear whether smoking status, including environmental tobacco smoke, increases stroke risk in patients with atrial fibrillation (AF). Abnormalities of the left atrium (LA) and aortic atherosclerosis, as detected by transesophageal echocardiography (TEE), are risk factors for stroke and thromboembolism in AF patients. We investigated the impact of smoking status on thromboembolic risk by TEE in patients with nonvalvular AF.MethodsIn 122 patients with AF (mean age, 63 years; chronic AF 50%) who underwent TEE before catheter ablation of AF or for detection of the potential cardioembolic source, urinary concentrations of cotinine and clinical variables including smoking status and the CHA2DS2-VASc score were determined.ResultsSevere aortic atherosclerosis and increased aortic wall thickness were more frequently detected by TEE in current smokers than in non-smokers (p<0.05), though these findings did not significantly differ between non-smokers and environmental smokers. Patients in AF rhythm during TEE, who were environmental smokers and at relatively low risk, as stratified by their CHA2DS2-VASc score (≤ 2), showed lower LA appendage flow velocity than those without environmental smoking (47±22 vs. 34±13 cm/sec, p<0.05).ConclusionsTEE findings indicated that smoking status could be associated with thromboembolic risk in patients with AF.

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

“…Chamberlain et al ( 18 ) showed a more than twofold increased risk of AF attributed to smoking, whereas current smoking was not a significant AF predictor in the Framingham risk score ( 19 ). Inao et al ( 20 ) revealed that current smokers had reduced LAAV and more often had dense left atrial spontaneous echo contrast, indicating an impact of smoking on thromboembolic risk in patients with AF. Other authors also found that smoking was associated with a higher thromboembolic risk in AF patients, even after adjustment for well-recognized risk factors used in stroke risk stratification schemes ( 21 ).…”