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Updated: May 23, 2025
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Predictors of left atrial thrombi for subsequent thromboembolisms: Risk factors derived from echocardiography
Tomoki Horie1, Shinsuke Miyazaki2, Yasutoshi Nagata1
1Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan.
Insights
Large left atrial thrombi (LATs) size, reduced ejection fraction, and mobility predict thromboembolism. Urgent surgical thrombectomy (UST) improved outcomes in high-risk patients with LATs.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Thrombosis Research
Background:
- Management strategies for left atrial thrombi (LATs) lack robust evidence.
- Identifying risk factors for thromboembolism in LAT patients is crucial.
Purpose of the Study:
- To investigate predictors of subsequent thromboembolism in patients with LATs.
- To explore the efficacy of different management approaches, including urgent surgical thrombectomy (UST).
Main Methods:
- Multicenter retrospective study involving 206 patients diagnosed with LATs via echocardiography.
- Evaluation of clinical and echocardiographic variables for association with symptomatic thromboembolism.
- Cox regression analysis to identify independent predictors of thromboembolism.
Main Results:
- 19.2% of patients developed thromboembolism during follow-up.
- Independent predictors of thromboembolism included LAT maximum length > 20 mm, reduced left ventricular ejection fraction (≤40%), and thrombus mobility.
- High-risk patients (≥2 factors) had a higher incidence of thromboembolism (23.1%) compared to low-risk patients (4.5%).
- Urgent surgical thrombectomy (UST) was associated with significantly lower adverse outcomes in high-risk patients at 90 days.
Conclusions:
- Large LAT size, reduced left ventricular ejection fraction, and thrombus mobility are significant risk factors for thromboembolism.
- UST demonstrated improved clinical outcomes in high-risk LAT patients, suggesting a potential therapeutic benefit.
Background:
Evidence regarding the management of left atrial thrombi (LATs) is limited.
Objectives:
We aimed to investigate factors associated with subsequent thromboembolism in patients with LATs and explored potential management approaches.
Methods:
This multicenter retrospective study consecutively enrolled patients who underwent morphological assessment of LAT using echocardiography. We evaluated associations between clinical and echocardiographic variables and the occurrence of symptomatic thromboembolism.
Results:
Two hundred six patients from 15 centers were enrolled. During follow-up period after echocardiographic diagnosis (651 days; interquartile range 174-1316 days), 19 patients (9.2%) developed thromboembolism. Cox regression analysis identified 3 independent predictors of thromboembolism: LAT maximum length > 20 mm (hazard ratio [HR] 2.63; 95% confidence interval [CI] 1.03-6.68; P=.043), reduced left ventricular ejection fraction (≤40%) (HR 2.95; 95% CI 1.14-7.63; P=.026), and thrombus mobility (HR 3.40; 95% CI 1.27-9.11; P=.015). Patients with ≥2 of these factors (52 [25.2%]) were categorized as the high-risk group, while those with <2 factors (154 [74.8%]) formed the low-risk group. Patients in the high-risk group had a higher incidence of thromboembolism (12 [23.1%] vs 7 [4.5%]; P<.001), despite a higher proportion undergoing urgent surgical thrombectomy (UST; 9 [17.3%] vs 9 [5.8%]; P=.025) compared with the low-risk group. In high-risk patients, UST was associated with a significantly lower rate of adverse outcomes, including all-cause mortality, heart failure hospitalizations, major bleeding, and thromboembolisms, at 90 days (0% vs 35.6%; log-rank, P=.048).
Conclusion:
In patients with LATs, large thrombus size, reduced left ventricular ejection fraction, and thrombus mobility were associated with subsequent thromboembolism. UST was associated with fewer adverse clinical outcomes in patients with ≥2 risk factors.
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