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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Spontaneous echo contrast, left atrial appendage thrombus and stroke in patients undergoing transcatheter aortic

Matthias Linder1, Lisa Voigtländer, Yvonne Schneeberger

  • 1Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.

Eurointervention : Journal of Europcr in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
|September 1, 2020
PubMed

Insights

Spontaneous echo contrast (SEC) is a risk factor for stroke after transcatheter aortic valve implantation (TAVI). Left atrial appendage thrombus (LAAT) is linked to increased mortality in TAVI patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Imaging

Background:

  • Transcatheter aortic valve implantation (TAVI) is a common procedure for aortic stenosis.
  • The role of pre-procedural thrombotic formations like spontaneous echo contrast (SEC) and left atrial appendage thrombus (LAAT) in TAVI outcomes is not well-defined.

Purpose of the Study:

  • To determine the prevalence of SEC and LAAT in patients undergoing TAVI.
  • To evaluate the impact of SEC and LAAT on periprocedural outcomes, specifically disabling ischemic stroke and long-term survival.

Main Methods:

  • Analysis of 1,558 consecutive TAVI patients from 2008-2017 with available imaging.
  • Patients were categorized into three groups: moderate/severe SEC, LAAT, and a reference group.
  • Primary outcome: disabling ischemic stroke within 24 hours. Secondary outcome: one-year survival.

Main Results:

  • Prevalence of LAAT was 4.4% and moderate/severe SEC was 5.4%.
  • Disabling ischemic stroke occurred more frequently in the SEC group (6.8%) versus reference (2.1%) and LAAT (1.9%) groups (p=0.020).
  • SEC was an independent risk factor for stroke (OR 3.54). One-year survival was significantly lower in LAAT (43.4%) and SEC (27.3%) groups compared to reference (18.7%, p<0.001).

Conclusions:

  • SEC and LAAT are present in a significant number of TAVI patients.
  • SEC is an independent risk factor for periprocedural stroke following TAVI.
  • LAAT is associated with increased one-year mortality after TAVI.
Abstract

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