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Published on: February 26, 2013
Cardiovascular Outcomes in Patients with Atrial Flutter and Oral Anticoagulation: The Predictive Role of Left Atrial
Łukasz Turek1, Marcin Sadowski1, Jacek Kurzawski1
1The Faculty of Medicine, Jan Kochanowski University, 25-369 Kielce, Poland.
Insights
In atrial flutter (AFL) patients receiving anticoagulation, left atrial appendage thrombus (LAAT) did not increase cardiovascular risks. However, higher CHA2DS2-VASc scores and reduced LVEF predicted poor prognosis.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- Atrial flutter (AFL) increases risks of stroke, heart failure (HF), and cardiovascular death.
- The role of left atrial appendage thrombus (LAAT) in AFL patients on anticoagulation regarding cardiovascular outcomes is not well-defined.
Purpose of the Study:
- To investigate the predictive value of LAAT for cardiovascular morbidity and mortality in AFL patients undergoing electrical cardioversion while on anticoagulation.
Main Methods:
- Prospective observational cohort study of 90 AFL patients.
- Primary endpoint: identification of LAAT via transesophageal echocardiography.
- Secondary endpoints: cardiovascular death, TIA, stroke, systemic thromboembolism, HF hospitalization, myocardial infarction over a median follow-up of 2114.5 days.
Main Results:
- LAAT was detected in 10% of patients; no significant difference in cardiovascular outcomes was observed between patients with and without LAAT.
- Higher CHA2DS2-VASc scores, prior myocardial infarction, and prior stroke/TIA/systemic thromboembolism were linked to increased HF hospitalization.
- Lower left ventricular ejection fraction (LVEF) correlated with higher rates of cardiovascular death.
Conclusions:
- LAAT did not significantly impact cardiovascular outcomes in this cohort of AFL patients on anticoagulation.
- CHA2DS2-VASc score, history of cardiovascular events, and LVEF are critical predictors of long-term prognosis in AFL.
Abstract:
Background/Objectives: The risks of blood clot formation, stroke, heart failure (HF), and cardiovascular death are enhanced in individuals with atrial flutter (AFL). However, it remains unclear whether left atrial appendage thrombus (LAAT) in individuals with AFL with anticoagulation enhances the risk of cardiovascular morbidity and mortality. Thus, in the current trial, we aimed to evaluate the predictive role of LAAT for cardiovascular outcomes in individuals with AFL who were receiving anticoagulation and admitted for electrical cardioversion. Methods: Ninety patients were included in this prospective observational cohort study. The primary endpoint was the identification of LAAT by transesophageal echocardiographic examination. All participants were observed for a median of 2114.5 (interquartile range, 1487.5-2591) days to identify the secondary endpoints: cardiovascular death, transient ischemic attack (TIA), stroke, systemic thromboembolic complications, hospitalization due to HF, or myocardial infarction. Results: LAAT was identified in nine (10%) patients. No differences in cardiovascular outcomes between patients with and without LAAT were documented. However, a higher CHA2DS2-VASc score, previous myocardial infarction, and previous stroke/TIA/systemic thromboembolism were associated with significantly higher rates of hospitalization due to HF. Decreased left ventricular ejection fraction (LVEF) was associated with significantly higher rates of cardiovascular death, underscoring the significance of this marker in disease prognosis. Conclusions: The impact of LAAT on cardiovascular outcomes was insignificant. Higher CHA2DS2-VASc scores, previous myocardial infarction, previous stroke/TIA/systemic thromboembolism, and lower LVEF significantly affected long-term prognosis and were associated with a poor prognosis.
