AUTHOR=Kaufmann Damian , Wabich Elżbieta , Kapłon-Cieślicka Agnieszka , Gawałko Monika , Budnik Monika , Uziębło-Życzkowska Beata , Krzesiński Paweł , Starzyk Katarzyna , Wożakowska-Kapłon Beata , Wójcik Maciej , Błaszczyk Robert , Hiczkiewicz Jarosław , Budzianowski Jan , Mizia-Stec Katarzyna , Wybraniec Maciej T. , Kosmalska Katarzyna , Fijałkowski Marcin , Szymańska Anna , Dłużniewski Mirosław , Haberka Maciej , Kucio Michał , Michalski Błażej , Kupczyńska Karolina , Tomaszuk-Kazberuk Anna , Wilk-Śledziewska Katarzyna , Wachnicka-Truty Renata , Koziński Marek , Burchardt Paweł , Daniłowicz-Szymanowicz Ludmiła TITLE=Echocardiographic predictors of thrombus in left atrial appendage—The role of novel transthoracic parameters JOURNAL=Frontiers in Cardiovascular Medicine VOLUME=9 YEAR=2022 URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.1059111 DOI=10.3389/fcvm.2022.1059111 ISSN=2297-055X ABSTRACT=Introduction

The left atrium appendage thrombus (LAAT) formation is a complex process. A CHA2DS2-VASc scale is an established tool for determining the thromboembolic risk and initiation of anticoagulation treatment in patients with atrial fibrillation or flutter (AF/AFL). We aimed to identify whether any transthoracic echocardiography (TTE) parameters could have an additional impact on LAAT detection.

Methods

That is a sub-study of multicenter, prospective, observational study LATTEE (NCT03591627), which enrolled 3,109 consecutive patients with AF/AFL referred for transesophageal echocardiography (TEE) before cardioversion or ablation.

Results

LAAT was diagnosed in 8.0% of patients. The univariate logistic regression analysis [based on pre-specified in the receiver operating characteristic (ROC) analysis cut-off values with AUC ≥ 0.7] identified left ventricular ejection fraction (LVEF) ≤ 48% and novel TTE parameters i.e., the ratios of LVEF and left atrial diameter (LAD) ≤ 1.1 (AUC 0.75; OR 5.64; 95% CI 4.03–7.9; p < 0.001), LVEF to left atrial area (LAA) ≤ 1.7 (AUC 0.75; OR 5.64; 95% CI 4.02–7.9; p < 0.001), and LVEF to indexed left atrial volume (LAVI) ≤ 1.1 (AUC 0.75, OR 6.77; 95% CI 4.25–10.8; p < 0.001) as significant predictors of LAAT. In a multivariate logistic regression analysis, LVEF/LAVI and LVEF/LAA maintained statistical significance. Calculating the accuracy of the abovementioned ratios according to the CHA2DS2-VASc scale values revealed their highest predictive power for LAAT in a setting with low thromboembolic risk.

Conclusion

Novel TTE indices could help identify patients with increased probability of the LAAT, with particular applicability for patients at low thromboembolic risk.