Risk factors for thrombosis and spontaneous echocardiographic contrast with sludge in atrial fibrillation patients...

Area of Science:

• Cardiology
• Medical Imaging
• Thrombosis Research

Background:

• Transesophageal echocardiography (TEE) and knowledge of thrombosis (T) risk predictors are crucial for safe electrical cardioversion in atrial fibrillation (AF) patients.
• Understanding these factors aids in patient selection and procedural safety.

Purpose of the Study:

• To investigate predictors of thrombosis (T) and spontaneous echocardiographic contrast (SEC) with sludge in the left atrium (LA) and appendage (LAA).
• To analyze these predictors in AF patients receiving oral anticoagulation (OAC).

Main Methods:

• A study involving 300 AF patients (duration >48 hours) was conducted.
• 219 patients received OACs (rivaroxaban, apixaban, dabigatran, VKAs), and 81 served as a control group without OACs.
• All patients underwent transthoracic echocardiography and TEE prior to electrical cardioversion.

Main Results:

• TEE identified LAA thrombosis in 4.7% of cases.
• The incidence of T or SEC4+ with sludge was similar between OAC and control groups (5.9% vs. 1.2% and 16.4% vs. 16.0%).
• Rivaroxaban showed the lowest risk of SEC4+/T (OR, 0.42), while VKAs showed the highest (OR, 2.49). Independent predictors included female sex, lower ejection fraction, and reduced LAA flow velocity.

Conclusions:

• Female sex, transthoracic echocardiography, and TEE findings are important for assessing T/SEC risk in LA/LAA patients with AF.
• These factors should be integrated into risk stratification protocols.