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06.03.2024 | Original Paper

Incidence and predictors of left atrial thrombus in patients with atrial fibrillation under anticoagulation therapy

verfasst von: Joong Min Lee, Myung-Jin Cha, Gi-Byoung Nam, Kee-Joon Choi, Byung Joo Sun, Dae-Hee Kim, Jong-Min Song, Duk-Hyun Kang, Jae-Kwan Song, Min Soo Cho

Erschienen in: Clinical Research in Cardiology

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Abstract

Background

Left atrial thrombus (LAT) formation is associated with thromboembolic events.

Objective

To investigate the incidence and associated factors of LAT in patients with atrial fibrillation (AF) who had been receiving anticoagulation therapy for more than 4 weeks, and to develop a prediction model using clinical and echocardiographic features.

Methods

Medical records of 1,122 patients with AF (mean age, 59.4 ± 11.0 years, 58.3% male) who were on anticoagulation more than 4 weeks and underwent transesophageal echocardiography (TEE) were evaluated. The main outcome was the presence of LAT on TEE.

Results

Warfarin and non-vitamin K oral anticoagulants were used in 74.4% and 25.6% of the patients at the time of examination, respectively. LAT was present in 60 patients (5.3%). Presence of LAT on TEE was associated with age ≥ 75 years (odds ratio [OR] 2.13 [95% confidence interval, 0.94–4.58]), persistent/permanent AF (OR 2.61 [1.42–4.93]), CHA₂DS₂-VASc score ≥ 3 points (OR 1.91 [1.05–3.48]), left ventricular ejection fraction < 40% (OR 2.35 [1.07–4.81]), and severe left atrial enlargement (OR 3.52 [1.89–6.79]). The presence of moderate-to-severe mitral regurgitation was associated with a lower risk of LAT (OR 0.13 [0.04–0.34]). A scoring system composed of the aforementioned predictors showed excellent discrimination performance (area under the curve 0.791 [95% CI, 0.727–0.854]).

Conclusions

LAT was present in a considerable number of patients who were already receiving anticoagulation therapy. A prediction model that combines clinical and echocardiographic predictors could be useful in distinguishing patients who require imaging evaluations before left atrial intervention.

Graphical abstract

Incidnece and predictors of LAT in patients with AF under anticoagulation therapy. AF, atrial fibrillation; CVS, CHA₂DS₂-VASc score; LA, left atrium; LAA, left atrial appendage; LAE, left atrial enlargement; LVEF, left ventricular ejection fraction; MR, mitral regurgitation; OAC, oral anticoagulant; PeAF, persistent atrial fibrillation; TEE, transesophageal echocardiography

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Titel: Incidence and predictors of left atrial thrombus in patients with atrial fibrillation under anticoagulation therapy
verfasst von: Joong Min Lee
Myung-Jin Cha
Gi-Byoung Nam
Kee-Joon Choi
Byung Joo Sun
Dae-Hee Kim
Jong-Min Song
Duk-Hyun Kang
Jae-Kwan Song
Min Soo Cho
Publikationsdatum: 06.03.2024
Verlag: Springer Berlin Heidelberg
Erschienen in: Clinical Research in Cardiology
Print ISSN: 1861-0684
Elektronische ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-024-02422-5

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Incidence and predictors of left atrial thrombus in patients with atrial fibrillation under anticoagulation therapy

Abstract

Background

Objective

Methods

Results

Conclusions

Graphical abstract

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Live-Webinar "Urologie und Sexualmedizin in der Praxis"

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Conclusions

Graphical abstract

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