Key result
Anticoagulation links to ~71% lower LA thrombus prevalence in NVAF inpatients.
Why the study?
Stroke in non-valvular atrial fibrillation is predominantly attributed to left atrial thrombus, but its real-world detection rate has been rarely reported in China.
What is the prevalence and what are the associated factors of left atrial thrombus in Chinese patients with non-valvular atrial fibrillation?
Cross-Sectional (n=36,007)
Yes
What is the prevalence and what are the associated factors of left atrial thrombus in Chinese patients with non-valvular atrial fibrillation?
Effect estimate: OR 0.29 (95% CI 0.25-0.34)
Absolute Event Rate: 2.1% vs 5%
p-value: p=<0.001
In a real-world Chinese cohort, left atrial thrombus was detected in 4.1% of NVAF patients undergoing TEE, with higher prevalence associated with non-paroxysmal AF, cardiovascular comorbidities, and lack of anticoagulation.
Anticoagulation was associated with lower thrombus prevalence in non-valvular AF; extends observational data but leaves causal effects and outcomes open.
Background: Stroke is predominately attributed to left atrial thrombus (LAT) in patients with non-valvular atrial fibrillation (NVAF), however, its detection rate in real clinical practice has been few reported in China. Objective: This study aimed to investigate the prevalence and associated factors of LAT in patients with NVAF in China. Methods: All adult NVAF patients undergoing transesophageal echocardiography (TEE) in the China Atrial Fibrillation Center database from January 2017 to January 2022 were enrolled in this study. The prevalence of LAT was calculated, and associated factors were identified. Results: score ≥ 2, left atrial diameter (LAD) ≥ 50 mm, left ventricular ejection fraction (LVEF) < 50%, and anticoagulation, patients with paroxysmal AF always had the lowest LAT prevalence, followed by patients with persistent and long-standing persistent AF. Patients treated with anticoagulants had less prevalent LAT than those without anticoagulation (2.1 vs. 5.0%, p < 0.001). In multivariate analysis, AF pattern (both persistent AF and long-standing persistent AF), hypertension, chronic heart failure, coronary heart disease, transient ischemic attack/stroke, diabetes mellitus, and LAD (per 5 mm) were associated with an increased prevalence of LAT. However, LVEF (per 5%) and anticoagulation were associated with a reduced prevalence of LAT. Conclusion: LAT was found in 4.1% of Chinese adult NVAF inpatients underwent TEE in real-world experience. The prevalence of LAT mainly associated with non-paroxysmal AF, cardiovascular diseases, diabetes mellitus, enlarged left atrium, lower LVEF, and lack of anticoagulation therapy.
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Shi et al. (2022) conducted a cross-sectional in Non-valvular atrial fibrillation (n=36,007). Anticoagulation vs. No anticoagulation was evaluated on Presence of left atrial thrombus on transesophageal echocardiography (OR 0.29, 95% CI 0.25-0.34, p=<0.001). Anticoagulation therapy was associated with a significantly reduced prevalence of left atrial thrombus (OR 0.29) compared to no anticoagulation in Chinese inpatients with non-valvular atrial fibrillation.