Key result
Reduced left ventricular ejection fraction was associated with a higher frequency of left atrial appendage thrombus compared to LVEF >50%.
Why the study?
Is lower left ventricular ejection fraction associated with an increased risk of left atrial appendage thrombus in patients with atrial fibrillation?
Cross-Sectional (n=768)
Yes
Is lower left ventricular ejection fraction associated with an increased risk of left atrial appendage thrombus in patients with atrial fibrillation?
Reduced left ventricular ejection fraction is an independent predictor of left atrial appendage thrombus in patients with atrial fibrillation, suggesting transesophageal echocardiography should be strongly considered before cardioversion or ablation in this subgroup even with adequate anticoagulation.
Answers are grounded in this paper and cite their sources.
TTE-derived parameters may refine LAA thrombus risk in AF; leaves open need for prospective validation before clinical use.
INTRODUCTION: Atrial fibrillation (AF) is associated with high risk of ischemic stroke. The most frequent thrombus location in AF is the left atrial appendage (LAA). Transthoracic echocardiography (TTE) is a basic diagnostic examination in patients (pts) with AF. OBJECTIVES: . The study group consisted of 768 pts with AF (mean age, 63 years), admitted to three high-reference cardiology departments. Five hundred and twenty-three pts were treated with non-vitamin K antagonist oral anticoagulants (NOACs) and 227 (30%) with vitamin K antagonists (VKAs). The subjects underwent TTE and transesophageal echocardiography (TEE) before cardioversion or ablation. RESULTS: LAAT was significantly more frequent in pts with reduced left ventricular ejection fraction (LVEF): in 10.6% (7 pts) with LVEF < 40% and in 9.0% (9 pts) with LVEF 40-49%, while only in 5.5% (33 pts) with LVEF > 50%. Compared to pts without LAAT, those with LAAT presented with lower LVEF and higher left atrial diameter (LAD). Multivariate logistic regression revealed the following variables as independent predictors of LAAT: previous bleeding, treatment with VKA, and LVEF. CONCLUSION: LAAT is related to lower LVEF and higher LAD. LVEF is one of the independent predictors of LAAT. Even in the case of adequate anticoagulant therapy, it might be prudent to consider TEE before cardioversion or ablation in patients with low LVEF and LA enlargement, especially in the coexistence of other thromboembolic risk factors.
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Uziębło‐Życzkowska et al. (2020) conducted a cross-sectional in Atrial Fibrillation (n=768). Reduced left ventricular ejection fraction (LVEF < 40%) vs. LVEF > 50% was evaluated on Left atrial appendage thrombus (LAAT). Reduced left ventricular ejection fraction was associated with a higher frequency of left atrial appendage thrombus compared to LVEF >50%.
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