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Updated: Oct 21, 2025

Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation

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Risk factors for left atrial thrombus or spontaneous echo contrast in non-valvular atrial fibrillation patients with

Jindong Chen1, Mengmeng Zhou1, Hao Wang1

  • 1Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.

Journal of Thrombosis and Thrombolysis
|September 3, 2021
PubMed

Insights

Elevated fibrinogen and enlarged left atrium (LA) are key risk factors for left atrial thrombus (LAT) or spontaneous echo contrast (LASEC) in non-valvular atrial fibrillation (NVAF) patients with low CHA₂DS₂-VASc scores. Incorporating these factors improves risk prediction accuracy.

Area of Science:

  • Cardiology
  • Internal Medicine
  • Thrombosis Research

Background:

  • Left atrial thrombus (LAT) and spontaneous echo contrast (LASEC) are complications in non-valvular atrial fibrillation (NVAF).
  • Existing risk stratification scores like CHA₂DS₂-VASc may underestimate risk in NVAF patients with low scores.
  • Limited data exists on specific risk factors for LAT/LASEC in this low-risk subgroup.

Purpose of the Study:

  • To identify and evaluate risk factors for LAT/LASEC in NVAF patients with low CHA₂DS₂-VASc scores.
  • To assess the predictive value of novel risk factors when added to the CHA₂DS₂-VASc score.

Main Methods:

  • Retrospective observational study analyzing transesophageal echocardiography (TEE) data from 3056 NVAF patients with low CHA₂DS₂-VASc scores.
  • Binary logistic regression and propensity score matching (PSM) were used to identify independent risk factors.
  • Receiver operating characteristic (ROC) analysis evaluated the enhanced predictive model.

Main Results:

  • Elevated fibrinogen levels and enlarged left atrium (LA) were identified as significant risk factors for LAT/LASEC.
  • PSM confirmed fibrinogen and LA size as independent predictors.
  • Adding fibrinogen and left atrial diameter (LAD) to the CHA₂DS₂-VASc score significantly improved LAT/LASEC prediction accuracy (AUC difference = 0.241).

Conclusions:

  • Elevated fibrinogen and enlarged LA are independent risk factors for LAT/LASEC in low-risk NVAF patients.
  • Integrating fibrinogen and LAD into risk assessment models can enhance the prediction of LAT/LASEC.
  • Further validation studies are recommended to confirm these findings.
Abstract

Keywords:
CHA2DS2-VASc scoreLeft atrial thrombusNon-valvular atrial fibrillationRisk factorsSpontaneous echo contrast

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