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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 in Patients with Hypertrophic Cardiomyopathy and Atrial Fibrillation

Raghav R Julakanti1, Kendra Gilreath2, Julia Debertin2

  • 1Minneapolis Heart Institute, St. Paul, Minnesota.

Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography
|June 10, 2026
PubMed

Insights

In hypertrophic cardiomyopathy (HCM) patients with atrial fibrillation (AF), reduced left atrial appendage emptying velocity (LAAEV) is linked to a higher risk of left atrial (LA) thrombus. This finding is crucial for managing anticoagulation and preventing thromboembolism.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Thrombosis Research

Background:

  • Patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF) face an elevated risk of left atrial (LA) thrombus.
  • The presence of LA thrombus complicates management, especially for interventions like cardioversion, due to increased thromboembolism risk.

Purpose of the Study:

  • To investigate predictors of LA thrombus in patients with HCM and AF.
  • To identify factors associated with LA thrombus presence despite anticoagulation therapy.

Main Methods:

  • Retrospective analysis of 693 patients with HCM and AF.
  • Inclusion of transesophageal echocardiogram (TEE) and transthoracic echocardiogram (TTE) data within one year.
  • Statistical analysis including univariate and multivariable logistic regression.

Main Results:

  • Left atrial appendage emptying velocity (LAAEV) was the only significant independent predictor of LA thrombus (OR 1.05; 95% CI 1.01-1.12, p=0.035).
  • Lower LAAEV was associated with a higher likelihood of LA thrombus.
  • Higher CHA2DS2-VASc score, lower left ventricular ejection fraction, and lower left ventricular outflow tract gradient were associated with LA thrombus on univariate analysis but not in multivariable analysis.

Conclusions:

  • Reduced LAAEV is a significant predictor of LA thrombus in patients with HCM and AF, even with appropriate anticoagulation.
  • These findings highlight the importance of assessing LAA function in this patient population.
Abstract

Keywords:
AnticoagulationAtrial fibrillationHypertrophic cardiomyopathyThrombusTransesophageal echocardiogram

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