Clinical InvestigationElectrophysiologyPredicting left atrial thrombi in atrial fibrillation
Section snippets
Study population
In a case control study design, Mayo Clinic Echocardiography Laboratory and Cardioversion Unit Databases (Rochester, MN) were used to identify all patients with nonvalvular AF who had LAAT detected by TEE (cases). Cases with heart valve prosthesis (biologic or mechanical) or more than moderate heart valve disease were excluded. Cases who had received warfarin, heparinoid, or direct thrombin inhibitor therapy within 30 days before TEE were also excluded.
The control group consisted of concurrent
Patient population
Between 1995 and 2005, there were 110 nonvalvular AF patients (mean age 72 ± 11 years, range 26-96 years, 39% women) who had LAAT detected by TEE (cases). Two patients of this group had thrombus within the left atrium cavity; all others had LAAT. Twenty cases had previously received warfarin; however, this medication had been stopped at least 30 days before LAAT detection. All patients had international normalized ratio ≤1.1 at the time of LAAT diagnosis.
For cases, the TEE indication was source
Discussion
There are 3 lines of evidence that embolic stroke in patients with AF originates in the LAA. First comes from pathology literature. Aberg26 was studying necropsy data from patients with valvular and nonvalvular AF dying from embolic stroke and found that thrombi within LAA were relatively common in patients with nonvalvular AF. Second, there are clinical data for AF patients undergoing TEE for source of embolism. In AF patients with acute thromboembolism, there was a high prevalence (43%) of
Disclosures
None of the authors have potential conflicts of interest to disclose.
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Cited by (70)
ACR Appropriateness Criteria® Workup of Noncerebral Systemic Arterial Embolic Source
2023, Journal of the American College of RadiologyEvaluating the novel parameters for assessing the LAA function and thrombus formation with nonvalvular atrial fibrillation
2021, Saudi Journal of Biological SciencesWhen it comes to the left atrial appendage, first do no harm
2020, Heart RhythmIncidence and Predictors of Intracardiac Thrombus on Pre-electrophysiological Procedure Transesophageal Echocardiography
2019, CJC OpenCitation Excerpt :CHADS2 and CHA2DS2-VASc score have consistently been identified as predictors of LAA thrombus; however, the individual comorbidities of heart failure and prior CVA/TIA have shown varied results.13,23,27-33 Our study results were similar to those of Wysokinski et al.,32 who reported an increased odds of thrombus associated with congestive heart failure (OR, 5.12; 95% CI, 2.91-9.03) and prior stroke (OR, 2.56; 95% CI, 1.37-4.76). Fukuda et al.,23 Willens et al.,30 and Yamashita et al.33 also showed heart failure as a risk factor in multivariate analyses, although prior CVA/TIA was not shown to be predictive of LAA thrombus.
Association between P-selectin levels and left atrial blood stasis in patients with nonvalvular atrial fibrillation
2018, Thrombosis ResearchCitation Excerpt :sPSL levels did not differ between cases and controls for those with very low stroke risk (CHA2DS2-VASc scores of 0). For those with CHA2DS2-VASc scores = 1 [29 (18–32) vs 19 [14–23] ng/mL; p = 0.0389] and score ≥ 2 [27 (21−32) vs 22 (14–30) ng/mL; p = 0.0317], sPSL levels were higher in NVAF cases compared to NSR controls. The same score values of CHADS2 system discriminated higher sPSL levels.
This study was supported by Mayo Clinic Foundation CR 20 grant.