Clinical Research in Cardiology ( IF 3.8 ) Pub Date : 2024-03-06 , DOI: 10.1007/s00392-024-02422-5 Joong Min Lee 1 , Myung-Jin Cha 1 , Gi-Byoung Nam 1 , Kee-Joon Choi 1 , Byung Joo Sun 1 , Dae-Hee Kim 1 , Jong-Min Song 1 , Duk-Hyun Kang 1 , Jae-Kwan Song 1 , Min Soo Cho 1
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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
中文翻译：
抗凝治疗房颤患者左心房血栓的发生率及预测因素
背景
左心房血栓（LAT）的形成与血栓栓塞事件相关。
客观的
旨在调查接受抗凝治疗超过 4 周的房颤 (AF) 患者 LAT 的发生率和相关因素，并利用临床和超声心动图特征建立预测模型。
方法
对 1,122 名接受抗凝治疗超过 4 周并接受经食管超声心动图 (TEE) 的 AF 患者（平均年龄 59.4 ± 11.0 岁，58.3% 男性）的医疗记录进行了评估。主要结果是 TEE 上存在 LAT。
结果
检查时分别有 74.4% 和 25.6% 的患者使用华法林和非维生素 K 口服抗凝剂。 60 名患者 (5.3%) 存在 LAT。 TEE 上 LAT 的存在与年龄 ≥ 75 岁（优势比 [OR] 2.13 [95% 置信区间，0.94–4.58]）、持续性/永久性 AF（OR 2.61 [1.42–4.93]）、CHA 2 DS 2 - VASc评分≥3分（OR 1.91 [1.05–3.48]），左心室射血分数<40%（OR 2.35 [1.07–4.81]），以及严重左心房扩大（OR 3.52 [1.89–6.79]）。中度至重度二尖瓣反流的存在与较低的 LAT 风险相关（OR 0.13 [0.04–0.34]）。由上述预测因子组成的评分系统表现出出色的辨别性能（曲线下面积 0.791 [95% CI，0.727–0.854]）。
结论
LAT 存在于相当多已经接受抗凝治疗的患者中。结合临床和超声心动图预测因子的预测模型可用于区分在左心房干预前需要进行影像学评估的患者。
图文摘要
接受抗凝治疗的 AF 患者 LAT 的发生率和预测因素。 AF，心房颤动； CVS、CHA 2 DS 2 -VASc 分数； LA，左心房； LAA，左心耳； LAE，左心房扩大； LVEF，左心室射血分数； MR，二尖瓣反流； OAC，口服抗凝剂； PeAF，持续性心房颤动； TEE-- 经食管超声心动图
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