Risk factors for left atrial appendage thrombus

Acta Cardiol. 2020 Aug;75(4):355-359. doi: 10.1080/00015385.2020.1757852. Epub 2020 Apr 28.

Abstract

Background: Atrial fibrillation (AF) is the most common persistent rhythm disorder that has been shown to be associated with a significant increase in stroke risk. Left atrial appendage (LAA) thrombi are responsible for most of strokes of cardiac origin. CHA2DS2-VASc is a risk scoring system to identify patients' indications for anticoagulation in nonvalvular AF patients. The aim of our study was to investigate CHA2DS2-VASc score, the other risk factors, echocardiographic data and blood parameters for LAA thrombus.Methods: Two hundred and sixty-four patients who were admitted to our adult cardiology outpatient clinic and who underwent a transesophageal echocardiography procedure between June 2017 and June 2019 included in our study. Patient's demographic data, transthoracic echocardiographic examinations, and laboratory results were recorded retrospectively.Results: LAA thrombus was detected in 39 (14.7%) patients. The rates of coronary artery disease and systolic dysfunction were significantly higher in patients with LAA thrombus (p = .017, p = .016, respectively). When AF subtypes were examined in detail, thrombus rate was significantly higher in persistent AF (51 vs. 25.7%, p = .002). Although the CHA2DS2-VASc score was slightly higher in the thrombus group, there was no statistically significant difference between the two groups (3.0 ± 1.65 vs. 2.78 ± 1.66).Conclusions: In conclusion, CHA2DS2-VASc score system itself was not informative about LAA thrombus formation although some of its components were related with LAA thrombus formation. According to a multiple regression analysis, the independent determinants of LAA thrombus were the presence of AF and coronary artery disease.

Keywords: Atrial fibillation; CHA2DS2-VASc score.

MeSH terms

  • Anticoagulants / administration & dosage*
  • Atrial Appendage* / diagnostic imaging
  • Atrial Appendage* / pathology
  • Atrial Fibrillation* / complications
  • Atrial Fibrillation* / epidemiology
  • Atrial Fibrillation* / physiopathology
  • Atrial Fibrillation* / therapy
  • Echocardiography, Transesophageal / methods
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Selection
  • Risk Adjustment
  • Risk Assessment / methods*
  • Risk Factors
  • Stroke* / etiology
  • Stroke* / prevention & control
  • Thrombosis* / diagnosis
  • Thrombosis* / etiology
  • Thrombosis* / physiopathology
  • Turkey / epidemiology

Substances

  • Anticoagulants