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Thromboembolic risks of left atrial thrombus detected by transesophageal echocardiogram
D Y Leung1, P M Davidson, G B Cranney
1Department of Cardiology, Prince Henry Hospital, Sydney, New South Wales, Australia.
Insights
Patients with left atrial thrombus face high risks of stroke and death. Key predictors of thromboembolism include large or mobile thrombi and prior thromboembolism history.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Left atrial thrombus is associated with a high risk of thromboembolic events.
- Prognosis and predictive features for patients with left atrial thrombus remain unclear.
Purpose of the Study:
- To identify predictors of thromboembolic events and mortality in patients with left atrial thrombus.
- To clarify the prognosis for patients diagnosed with left atrial thrombus.
Main Methods:
- Transesophageal echocardiograms were performed in 2,894 patients over 6.5 years.
- Ninety-four patients with left atrial thrombus were analyzed for clinical outcomes.
- Cox proportional hazard regression was used to identify significant predictors.
Main Results:
- The event rate for stroke or embolism was 10.4% per year, and mortality was 15.8% per year.
- Predictors of thromboembolism included maximum thrombus dimension ≥1.5 cm, history of thromboembolism, and mobile thrombus.
- Left ventricular dysfunction predicted mortality, while other factors like atrial fibrillation did not.
Conclusions:
- Patients with left atrial thrombus have a significant risk of stroke, embolism, and death.
- Thrombus size, mobility, and history of thromboembolism are crucial for predicting future events.
- Aggressive antithrombotic therapy may be warranted for high-risk individuals.
Abstract:
Patients with left atrial thrombus are considered at high risk for thromboembolic events. The actual prognosis of these patients and the features most predictive of future events are unclear. We performed transesophageal echocardiograms in 2,894 patients over a 6 1/2-year period; 94 (age 69 +/- 11 years, 59 men, 83 in atrial fibrillation) were found to have left atrial thrombus. The thrombi were considered mobile in 45 patients and 33 patients had thrombus with a maximum dimension > or = 1.5 cm. Seven of the 94 patients with prosthetic valves were excluded from follow-up analysis. Over a follow-up period of 25.3 +/- 19.2 months, 17 patients had suffered a stroke or embolic event (event rate 10.4% per year) and 27 had died (mortality 15.8% per year). Cox proportional hazard regression analysis identified a maximum thrombus dimension > or = 1.5 cm (RR 19, p = 0.002), history of thromboembolism (RR 4.2, p = 0.038), and mobile thrombus (RR 5.3, p = 0.02) as predictors of subsequent thromboembolism. Moderate or severe left ventricular dysfunction was the only significant predictor of death (RR 2.9, p = 0.04). Gender, age, warfarin therapy at follow-up, atrial fibrillation, location (cavity vs appendage) of thrombus, and spontaneous echocardiographic contrast were not significant. Aggressive antithrombotic therapy may be indicated in these high-risk patients.