Prevalence and Predictors of Left Atrial Appendage Thrombus by Sex

Background Women with atrial fibrillation (AF) have historically been considered to have higher thromboembolic risk than men. The CHA 2 DS 2 -VASc score treated female sex as an independent risk factor. Recent guidelines recommend CHA 2 DS 2 -VA score, redefining female sex as a risk modifier. Aims This study aimed to assess the prevalence of left atrial appendage thrombus (LAAT) by sex and identify independent predictive factors for LAAT. Methods This analysis used data from the multicenter, prospective Left Atrial Thrombus on Transesophageal Echocardiography (LATTEE) registry, including 3,109 patients with AF. All patients underwent preprocedural transesophageal echocardiography to assess LAAT. Results Women constituted 36.5% of the study population. They were older, had more comorbidities, higher CHA 2 DS 2 -VA scores compared with men (median 3 vs. 2, p < 0.001). Among 3034 patients, LAAT was detected in 7.7% of cases, without significant difference between sexes (8% vs. 7.2%, p = 0.42). In multivariable logistic regression, paroxysmal AF was associated with lower odds of LAAT (OR 0.35), smoking (OR 1.71), reduced left ventricular ejection fraction (LVEF) <50% (OR 1.94), DOAC use (OR 0.42), and LAAV (per 1 cm/s increase; OR 0.92) were independent predictors of LAAT in men. In women only LAAV (per 1 cm/s increase; OR 0.91) remained significant ( p < 0.001). No sex-related effect modification was observed ( p > 0.05). Conclusions Although women with AF present a more adverse clinical profile, sex itself was not an independent predictor of LAAT.