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Published on: July 20, 2022
Left Ventricular Ejection Fraction Can Predict Atrial Thrombosis Even in Non-High-Risk Individuals with Atrial
Petra Angebrandt Belošević1, Anton Šmalcelj2, Nikola Kos3
1Department of Cardiovascular Diseases, University Hospital Center Zagreb, 10000 Zagreb, Croatia.
Insights
Left ventricle ejection fraction (LVEF) predicts left atrial thrombosis (LAT) in atrial fibrillation (AF) patients, even those on anticoagulation. This finding improves thromboembolic risk assessment, particularly for lower-risk AF patients.
Area of Science:
- Cardiology
- Medical Imaging
- Thrombosis Research
Background:
- Current guidelines advise against routine transesophageal echocardiography (TOE) for anticoagulated atrial fibrillation (AF) patients.
- Identifying predictors for left atrial thrombosis (LAT) is crucial for guiding TOE decisions in AF patients undergoing anticoagulation.
- Real-world clinical, laboratory, and echocardiographic data are valuable for this risk stratification.
Purpose of the Study:
- To identify predictors of left atrial thrombosis (LAT) in anticoagulated atrial fibrillation (AF) patients requiring transesophageal echocardiography (TOE).
- To evaluate the utility of left ventricle ejection fraction (LVEF) in predicting LAT.
- To assess the impact of LVEF on thromboembolic risk stratification models.
Main Methods:
- Analysis of electronic medical records from 838 consecutive AF patients between 2014-2017.
- Patients were referred for pulmonary vein isolation or direct current cardioversion.
- Multivariable and univariable logistic regression models were used to identify LAT predictors, with TOE as the primary endpoint.
Main Results:
- Left atrial thrombosis (LAT) was present in 15.8% of patients (132/838).
- Left ventricle ejection fraction (LVEF) was the only statistically significant independent predictor of LAT (OR 0.956, p < 0.01).
- Including LVEF improved the predictive accuracy of risk models (AUC 0.76), especially in non-high thromboembolic risk subgroups (CHA2DS2-Vasc score 0 or 1).
Conclusions:
- Left ventricle ejection fraction (LVEF) is an independent predictor of left atrial thrombosis (LAT) in atrial fibrillation (AF) patients.
- LVEF can enhance thromboembolic risk stratification models, including the CHA2DS2-Vasc score.
- LVEF aids in identifying LAT in AF patients considered at lower thromboembolic risk.
Abstract:
Background—Current guidelines do not recommend routine use of transesophageal echocardiography (TOE) in anticoagulated patients with atrial fibrillation (AF). The aim of our study was to identify predictors for left atrial thrombosis (LAT) in patients with AF that would require TOE despite anticoagulation therapy, using clinical, laboratory and echocardiographic data which are usually obtained in those patients in a real-world setting. Methods—We analyzed data from electronic medical records (EMR) of consecutive AF patients referred to two university hospitals between January 2014 and December 2017 for pulmonary vein isolation (PVI) or direct current cardioversion. The primary endpoint was the presence of left atrial thrombus on TOE. Multivariable and univariable logistic regression models were computed using variables that were significantly different between the LAT and the control groups. Results—A total of 838 patients were included, of whom 132 (15.8%) had LAT. After controlling for other variables, only the left ventricle ejection fraction (LVEF) remained statistically significant with an OR of 0.956 (95% CI 0.934−0.979), p < 0.01. Regression models including LVEF had significantly higher areas under the receiver operating characteristic (ROC) curves, including in subgroups with non-high thromboembolic risk (CHA2DS2-Vasc = 0 or 1), with an area under the curve (AUC) of 0.76 (95% CI 0.71−0.81), p < 0.0001. Conclusions—The LVEF is an independent predictor of LAT, and it might improve thromboembolic risk stratification in future models. LVEF significantly increased the predictive value of the CHA2DS2-Vasc model and was able to identify LAT in non-high-risk patients.
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