Background
Methods
Study design
- Documented history of AF, atrial high-rate episodes (AHRE) recorded by cardiac implantable electronic devices (CIED), or any other indication for anticoagulation or receiving anticoagulation within 30 days prior to the enrolment.
- Potentially confounding valvular heart disease (any mitral stenosis, moderate or severe aortic stenosis or regurgitation, severe mitral or tricuspid regurgitation).
- Active cancer.
- Inability to provide informed consent.
Data collection
Transthoracic echocardiography
Transesophageal echocardiography
Left atrial strain analysis
Statistical analysis
Results
Study population
All patients (n = 63) | With LAAT (n = 20, 31.7%) | Without LAAT (n = 43, 68.3%) | p-value | ||||
---|---|---|---|---|---|---|---|
Age (years) | 61.9 | (±10.9) | 62.8 | (±9.9) | 61.5 | (±11.4) | 0.67 |
Male sex | 60 | (95.2%) | 20 | (100%) | 40 | (93%) | 0.57 |
Heart rate (bpm) | 77.3 | (±10.9) | 76.0 | (±10.8) | 78.0 | (±11.1) | 0.51 |
BMI (kg/m2) | 26.2 | (±4.5) | 26.1 | (±4.7) | 26.3 | (±4.5) | 0.83 |
BSA (m2) | 1.9 | (±0.2) | 1.9 | (±0.2) | 1.9 | (±0.2) | 0.4 |
Ischaemic HF aetiology | 33 | (52.4%) | 13 | (65%) | 20 | (46.5%) | 0.17 |
Hypertension | 34 | (54%) | 11 | (55%) | 23 | (53.5%) | 0.91 |
Diabetes | 21 | (33.3%) | 5 | (25%) | 16 | (37.2%) | 0,34 |
Chronic kidney disease | 28 | (44.4%) | 9 | (45%) | 19 | (44.2%) | 0.95 |
History of stroke or TIA | 7 | (11.1%) | 3 | (15%) | 4 | (9.3%) | 0.81 |
CHA2DS2-VASc score | 3 | (2–4) | 3 | (2–5) | 3 | (2–4) | 0.65 |
NYHA class | 0.59 | ||||||
I | 0 | (0%) | 0 | (0%) | 0 | (0%) | |
II | 7 | (11.1%) | 3 | (15%) | 4 | (9.3%) | |
III | 34 | (54%) | 9 | (45%) | 25 | (58.1%) | |
IV | 22 | (34.9%) | 8 | (40%) | 14 | (32.6%) | |
Aspirin | 52 | (82.5%) | 17 | (85%) | 35 | (81.4%) | 0.99 |
Other antiplatelet agent | 11 | (17.5%) | 6 | (30%) | 5 | (11.6%) | 0.15 |
Statin | 39 | (61.9%) | 12 | (60%) | 27 | (62.8%) | 0.83 |
Diuretic | 62 | (98.4%) | 19 | (95%) | 43 | (100%) | 0.69 |
Beta-blocker | 58 | (92.1%) | 18 | (90%) | 40 | (93%) | 0.93 |
ACE-I or ARB | 43 | (68.3%) | 16 | (80%) | 27 | (62.8%) | 0.17 |
MRA | 53 | (84.1%) | 16 | (80%) | 37 | (86.1%) | 0.81 |
Calcium channel blocker | 2 | (3.2%) | 0 | (0%) | 2 | (4.7%) | 0.84 |
Digoxin | 2 | (3.2%) | 0 | (0%) | 2 | (4,7%) | 0.84 |
LA diameter (cm) | 5.0 | (±0.4) | 5.0 | (±0.3) | 5.1 | (±0.5) | 0.6 |
LAA (cm2) | 31.3 | (±7.4) | 31.1 | (±5.5) | 31.4 | (±8.1) | 1 |
LAVI (ml/m2) | 62.1 | (±13.3) | 68.6 | (±9.9) | 59.1 | (±13.7) | 0.01 |
LVEF (%) | 19.2 | (±4.1) | 18.9 | (±5) | 19.4 | (±3.7) | 0.99 |
E/A | 2.4 | (±1.1) | 2.7 | (±1.3) | 2.3 | (±1) | 0.28 |
E/e` | 24.2 | (±8.4) | 23.6 | (±8.3) | 24.5 | (±8.5) | 0.66 |
Global PALS (%) | 8.9 | (±2) | 7.2 | (±2.1) | 9.7 | (±1.3) | < 0.001 |
Global PACS (%) | −4.0 | (±1.2) | −3.6 | (±1.1) | −4.2 | (±1.2) | 0.04 |
All patients (n = 63) | With LAAT (n = 20, 31.7%) | Without LAAT (n = 43, 68.3%) | p-value | ||||
---|---|---|---|---|---|---|---|
Death | 16 | (25.4%) | 5 | (25%) | 11 | (25.6%) | 0.96 |
Hospitalization for ischemic stroke | 3 | (4.8%) | 2 | (10%) | 1 | (2.3%) | 0.49 |
Composite endpoint a | 18 | (28.6%) | 7 | (35%) | 11 | (25,6%) | 0.44 |
Primary objective - LAAT predictors
OR | −95% CI OR | 95% CI OR | p-value | Gini coefficient | |
---|---|---|---|---|---|
Global PALS (%) | 0.43 | 0.29 | 0.65 | < 0.001 | 0.65 |
LAVI (ml/m2) | 1.06 | 1.01 | 1.11 | 0.01 | 0.44 |
Global PACS (%) | 1.67 | 1.02 | 2.75 | 0.04 | 0.36 |
Other antiplatelet agent | 3.27 | 0.86 | 12.39 | 0.08 | 0.18 |
Ischaemic HF etiology | 2.14 | 0.71 | 6.4 | 0.18 | 0.18 |
ACE-I or ARB | 2.37 | 0.67 | 8.34 | 0.18 | 0.17 |
Diabetes | 0.56 | 0.17 | 1.84 | 0.34 | 0.12 |
BSA (m2) | 0.26 | 0.01 | 5.73 | 0.4 | 0.11 |
E/A | 1.31 | 0.80 | 2.16 | 0.28 | 0.1 |
LA diameter (cm) | 0.71 | 0.2 | 2.51 | 0.59 | 0.1 |
E/e` | 0.99 | 0.92 | 1.05 | 0.66 | 0.1 |
CHA2DS2-VASc score | 1.02 | 0.75 | 1.39 | 0.9 | 0.08 |
BMI (kg/m2) | 0.99 | 0.88 | 1.11 | 0.82 | 0.07 |
Heart rate (bpm) | 0.98 | 0.94 | 1.03 | 0.5 | 0.06 |
History of stroke or TIA | 1.72 | 0.35 | 8.54 | 0.51 | 0.06 |
MRA | 0.65 | 0.16 | 2.62 | 0.54 | 0.06 |
Aspirin | 1.3 | 0.30 | 5.51 | 0.73 | 0.04 |
NYHA class | 0.03 | ||||
II | 1.4 | 0.48 | 4.08 | 0.54 | |
III | 0.67 | 0.31 | 1.45 | 0.31 | |
IV | 1.07 | 0.48 | 2.38 | 0.88 | |
Beta-blocker | 0.68 | 0.10 | 4.4 | 0.68 | 0.03 |
Statin | 0.89 | 0.30 | 2.64 | 0.83 | 0.03 |
Age (years) | 1.01 | 0.96 | 1.06 | 0.67 | 0.02 |
Hypertension | 1.06 | 0.37 | 3.08 | 0.91 | 0.02 |
LVEF (%) | 0.97 | 0.85 | 1.11 | 0.66 | 0.01 |
Chronic kidney disease | 1.03 | 0.36 | 3.00 | 0.95 | 0.01 |
LAA (cm2) | 0.99 | 0.92 | 1.07 | 0.85 | 0 |
Reliability and reproducibility of PALS measurements
Secondary objective - composite endpoint of death or hospitalization for ischemic stroke
OR | −95% CI OR | 95% CI OR | p-value | Gini coefficient | |
---|---|---|---|---|---|
CHA2DS2-VASc score | 1.51 | 1.07 | 2.12 | 0.02 | 0.38 |
Age (years) | 1.07 | 1.00 | 1.12 | 0.06 | 0.37 |
BSA (m2) | 0.03 | 0.001 | 1.01 | 0.05 | 0.37 |
Chronic kidney disease | 3.63 | 1.14 | 11.5 | 0.03 | 0.31 |
NYHA class | 0.31 | ||||
II | 0.50 | 0.12 | 2.18 | 0.36 | |
III | 0.79 | 0.31 | 2.01 | 0.61 | |
IV | 2.52 | 0.98 | 6.47 | 0.05 | |
Heart rate (bpm) | 0.95 | 0.91 | 1.01 | 0.08 | 0.28 |
ACE-I or ARB | 0.32 | 0.1 | 1.02 | 0.05 | 0.26 |
Diabetes | 2.75 | 0.88 | 8.56 | 0.08 | 0.23 |
Ischaemic HF etiology | 2.29 | 0.73 | 7.16 | 0.16 | 0.2 |
History of stroke or TIA | 4.00 | 0.80 | 20.1 | 0.09 | 0.16 |
LA diameter (cm) | 1.16 | 0.32 | 4.15 | 0.82 | 0.12 |
LAAT | 1.57 | 0.50 | 4.93 | 0.44 | 0.1 |
Aspirin | 2.00 | 0.39 | 10.3 | 0.41 | 0.09 |
LAVI (ml/ m2) | 1.01 | 0.97 | 1.05 | 0.74 | 0.09 |
LVEF (%) | 0.96 | 0.84 | 1.09 | 0.50 | 0.09 |
MRA | 0.54 | 0.13 | 2.19 | 0.39 | 0.09 |
BMI (kg/m2) | 1.00 | 0.89 | 1.13 | 0.94 | 0.08 |
E/e` | 1.01 | 0.94 | 1.07 | 0.85 | 0.07 |
Global PACS (%) | 1.13 | 0.71 | 1.79 | 0.62 | 0.07 |
E/A | 1.11 | 0.68 | 1.84 | 0.67 | 0.06 |
Global PALS (%) | 0.97 | 0.74 | 1.29 | 0.84 | 0.05 |
Beta-blocker | 0.57 | 0.09 | 3.74 | 0.56 | 0.04 |
Digoxin | 2.59 | 0.15 | 43.7 | 0.51 | 0.03 |
LA area (cm2) | 0.99 | 0.92 | 1.07 | 0.83 | 0.03 |
Hypertension | 1.09 | 0.37 | 3.28 | 0.87 | 0.02 |
Female sex | 1.27 | 0.11 | 14.9 | 0.85 | 0.01 |
Other antiplatelet agent | 0.93 | 0.22 | 3.97 | 0.92 | 0.01 |
Statin | 0.95 | 0.31 | 2.93 | 0.93 | 0.01 |
OR | −95% CI OR | 95% CI OR | p-value | |
---|---|---|---|---|
CHA2DS2-VASc score | 1.7 | 1.2 | 2.5 | 0.006 |
ACE-I or ARB | 0.2 | 0.05 | 0.8 | 0.02 |
BSA (m2) | 0.02 | 0.0003 | 0.9 | 0.046 |