Key result
Left atrial thrombus and dense spontaneous echo contrast were not independently associated with stroke or death in anticoagulated patients with AF and low CHADS2 score (OR 1.55; 95% CI 0.50-4.83).
Why the study?
Does the presence of left atrial thrombus or dense spontaneous echo contrast increase the risk of stroke or death in patients with non-valvular AF and low CHADS2 score undergoing cardioversion?
Cohort (n=295)
No
Does the presence of left atrial thrombus or dense spontaneous echo contrast increase the risk of stroke or death in patients with non-valvular AF and low CHADS2 score undergoing cardioversion?
Odds Ratio: 1.55 (95% CI 0.5–4.83)
Despite a low CHADS2 score, 11% of patients have LA thrombus or dense SEC, predicted by EF <40% and LA diameter ≥50 mm, suggesting echocardiography may aid risk stratification.
Does not support altering periprocedural management based on LA thrombus or dense SEC in anticoagulated low-CHADS2 AF; leaves open need for prospective validation.
AIMS: To evaluate the prevalence and clinical impact of left atrial (LA) thrombus and dense spontaneous echo contrast (SEC) in patients with atrial fibrillation (AF) and low CHADS(2) score undergoing cardioversion. METHODS AND RESULTS: A total of 295 consecutive patients with non-valvular AF and a CHADS(2) score of 0 or 1 from the prospective single-centre registry ANTIK, who underwent transoesophageal echocardiography before cardioversion, were included in the study. Median follow-up was 5 years. LA thrombus was present in 3% and dense SEC in 8% of patients. Independent predictors for the presence of thrombus or dense SEC were ejection fraction (EF) <40% and LA diameter > or =50 mm. In anticoagulated patients, thrombus and dense SEC were not independently associated with an increased risk for stroke or death during the 5 year follow-up (OR 1.55, 95% CI 0.50-4.83). CONCLUSIONS: Despite a low CHADS(2) score of 0/1, 3% of patients have LA thrombus and 8% of patients have dense SEC. Independent predictors for the presence of thrombus and dense SEC were EF <40% and LA dimension > or =50 mm. Thus, echocardiography might be a useful tool for further risk stratification in patients with low CHADS(2) score.
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Kleemann et al. (2008) conducted a cohort in Non-valvular atrial fibrillation with low CHADS2 score (n=295). Left atrial thrombus and dense spontaneous echo contrast vs. Absence of left atrial thrombus and dense spontaneous echo contrast was evaluated on Stroke or death (OR 1.55, 95% CI 0.50-4.83). Left atrial thrombus and dense spontaneous echo contrast were not independently associated with stroke or death in anticoagulated patients with AF and low CHADS2 score (OR 1.55; 95% CI 0.50-4.83).
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