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Published on: July 20, 2022
Correlation between left atrial spontaneous echocardiographic contrast and 5-year stroke/death in patients with
Laurie Soulat-Dufour1, Sylvie Lang2, Arnaud Etienney2
1Service de Cardiologie, Hôpitaux Saint-Antoine and Tenon, AP-HP, 75012 Paris, France; INSERM UMRS-ICAN 1166, "Unité de recherche sur les maladies cardiovasculaires, du métabolisme et de la nutrition", 75013 Paris, France.
Insights
Left atrial spontaneous echocardiographic contrast (LASEC) detected via echocardiography is a significant predictor of stroke and death in non-valvular atrial fibrillation (NVAF) patients. Incorporating LASEC into risk scores may improve stroke prediction in NVAF.
Area of Science:
- Cardiology
- Medical Imaging
- Clinical Prognostics
Background:
- Transthoracic echocardiography (TTE) and transoesophageal echocardiography (TOE) are diagnostic tools for left atrial thrombus and left atrial spontaneous echocardiographic contrast (LASEC).
- Non-valvular atrial fibrillation (NVAF) is a common condition associated with an increased risk of stroke.
Purpose of the Study:
- To assess the prognostic value of TTE and TOE in predicting stroke and all-cause mortality over a 5-year period in patients diagnosed with NVAF.
- To determine if LASEC, identified through echocardiography, can serve as an independent predictor of adverse outcomes in NVAF patients.
Main Methods:
- A retrospective study involving patients hospitalized with NVAF between 1998 and 2011.
- Patients underwent TTE and TOE within 24 hours of admission.
- Cox proportional-hazards models were utilized to identify predictors of a composite outcome including stroke or all-cause death.
Main Results:
- Over 5 years, 20.5% of patients experienced stroke or death.
- Independent predictors of adverse events included CHA2DS2-VASc score, larger left atrial area, and moderate to severe LASEC.
- Dyslipidaemia and anti-arrhythmic medication at discharge were protective factors.
- Adding LASEC to the CHA2DS2-VASc score improved predictive accuracy (C index 0.71 vs. 0.69).
Conclusions:
- Moderate to severe LASEC is an independent predictor of stroke and death in NVAF patients at 5-year follow-up.
- Integrating LASEC into existing stroke risk scores may enhance risk stratification for NVAF patients.
Background:
Transthoracic echocardiography (TTE) and transoesophageal echocardiography (TOE) can be used to detect the presence of left atrial thrombus and left atrial spontaneous echocardiographic contrast (LASEC).
Aim:
To evaluate the prognostic value of TTE and TOE in predicting stroke and all-cause death at 5-year follow-up in patients with non-valvular atrial fibrillation (NVAF).
Methods:
This study included patients hospitalised with electrocardiography-diagnosed NVAF in Saint-Antoine University Hospital, Paris, between July 1998 and December 2011, who underwent TTE and TOE evaluation within 24hours of admission. Cox proportional-hazards models were used to identify predictors of the composite outcome (stroke or all-cause death).
Results:
During 5 years of follow-up, stroke/death occurred in 185/903 patients (20.5%). By multivariable analysis, independent predictors of stroke/death were CHA2DS2-VASc score (hazard ratio [HR] 1.35, 95% confidence interval [CI] 1.25-1.47; P<0.001), left atrial area>20 cm2 (HR 1.59, 95% CI 1.08-2.35; P=0.018), moderate LASEC (HR 1.72, 95% CI 1.13-2.62; P=0.012) and severe LASEC (HR 2.04, 95% CI 1.16-3.58; P=0.013). Independent protective predictors were dyslipidaemia (HR 0.60, 95% CI 0.43-0.83; P=0.002) and discharge prescription of anti-arrhythmics (HR 0.59, 95% CI 0.40-0.87; P=0.008). Adding LASEC to the CHA2DS2-VASc score modestly improved predictive accuracy and risk classification, with a C index of 0.71 vs. 0.69 (P=0.004).
Conclusions:
In this retrospective monocentric study, the presence of moderate/severe LASEC was an independent predictor of stroke/death at 5-year follow-up in patients with NVAF. The inclusion of LASEC in stroke risk scores could modestly improve risk stratification.
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