Evaluating the novel parameters for assessing the LAA function and thrombus formation with nonvalvular atrial fibrillation

Q: What are the key findings of this study?

In patients with non-valvular atrial fibrillation, LAAEF (OR 4.09, P<0.01), LAAVI (OR 3.28, P<0.01), and AF time (OR 1.73, P<0.05) were independent predictors of LAA thrombus or severe SEC.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Non-valvular atrial fibrillation (NVAF) (n=102). Intervention: RT-3D-TEE parameters (LAAEF, LAAVI, AF time). Primary outcome: Left atrial appendage thrombus (LAAT) or severe spontaneous echocardiographic contrast (SSEC) (OR 4.09 (LAAEF), OR 3.28 (LAAVI), OR 1.73 (AF time), p=<0.01).

Jian Li; Quan Li; Fatmah S. AlQahtany; Farjah Algahtani; Hak‐Jae Kim; Yang Li; Young Ock Kim

doi:10.1016/j.sjbs.2020.10.041

November 2, 2020Saudi Journal of Biological SciencesOpen Access

Evaluating the novel parameters for assessing the LAA function and thrombus formation with nonvalvular atrial fibrillation

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Key result

LAAEF, LAAVI, and AF time independently predict LAA thrombus or severe SEC in non-valvular AF.

OR 4.09 (LAAEF), OR 3.28 (LAAVI), OR 1.73 (AF time)
P<0.01
n=102

Figures

Why the study?

Traditional 2D-TEE cannot accurately evaluate LAA function in patients with NVAF prone to thrombus formation.

Do RT-3D-TEE derived parameters of LAA function predict thrombus formation in patients with non-valvular atrial fibrillation?

Study Design

Type

Observational (n=102)

Structured PICO

Do RT-3D-TEE derived parameters of LAA function predict thrombus formation in patients with non-valvular atrial fibrillation?

P

Population

102 patients with non-valvular atrial fibrillation (NVAF) lasting ≥48 hours and not on anticoagulation therapy. Mean age 59.99 ± 11.01, 71 males. Excluded: rheumatic heart disease, valvular heart disease, thrombocytopenic purpura, and severe mitral regurgitation.

I

Intervention

Real-time three-dimensional transesophageal echocardiography (RT-3D-TEE) to measure left atrial appendage (LAA) function parameters (LAAEF, LAAVI, LAA-OAmax, etc.)

O

Outcome

Presence of left atrial appendage thrombus (LAAT) or severe spontaneous echocardiographic contrast (SSEC)surrogate

Main Result

Effect estimate: OR 4.09 (LAAEF), OR 3.28 (LAAVI), OR 1.73 (AF time)

p-value: p=<0.01

Limitations

Small sample capacity
Grouping method (taking severe SEC into thrombi group)

Implication

Supports RT-3D-TEE LAA metrics for NVAF thrombus prediction; hypothesis-generating and should not yet change practice.

Abstract

The dysfunction of left atrial appendage (LAA) is prone to form thrombus when atrial fibrillation (AF) sustained more than 48 h. Traditional 2D-TEE (transesophageal echocardiography) can not accurate evaluate the function of LAA. The purpose of this study is to analyze the relationship of LAA function parameters and thrombus formation in patients with non-valvular atrial fibrillation (NVAF) by real-time three-dimensional transesophageal echocardiography (RT-3D-TEE). High risk patients can be identified according to the characteristics of ultrasonic index in patients with left atrial appendage thrombosis, which has important clinical value and significance in the risk assessment, guiding treatment and judging prognosis. We examined the relationship between the echocardiographic parameters of LAA function and the incidence of thrombus in 102 NVAF patients. They underwent RT-3D-TEE and left atrial appendage thrombus (LAAT)/severe spontaneous echocardiographic contrast (SSEC) was found in 67 patients (thrombus group) but absent in the remaining 35 patients (non-thrombus group). After measured by QLAB software, the LAA functional parameters were significantly associated with LAAT/SEC formation. Univariate analysis indicated that AF time, LAD, LVEF, LAA-OAmax, LAAVmax, LAAVI and LAAEF demonstrated a positive association (P < 0.05). However, logistic regression analysis identified that AF time (OR:1.73, P < 0.05)、LAAEF (OR:4.09, P < 0.01)and LAAVI (OR:3.28, P < 0.01) were independent predictors of LAAT/SSEC. In patients with nonvalvular atrial fibrillation, echocardiographic parameters of LAA function are significantly associated with LAAT/SSEC.

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Cite This Study

Li et al. (2020) conducted an observational in Non-valvular atrial fibrillation (NVAF) (n=102). RT-3D-TEE parameters (LAAEF, LAAVI, AF time) was evaluated on Left atrial appendage thrombus (LAAT) or severe spontaneous echocardiographic contrast (SSEC) (OR 4.09 (LAAEF), OR 3.28 (LAAVI), OR 1.73 (AF time), p=<0.01). In patients with non-valvular atrial fibrillation, LAAEF (OR 4.09, P<0.01), LAAVI (OR 3.28, P<0.01), and AF time (OR 1.73, P<0.05) were independent predictors of LAA thrombus or severe SEC.

synapsesocial.com/papers/6a0662ba3f8bf83a443dd911 https://doi.org/10.1016/j.sjbs.2020.10.041