What is the clinical evidence from this study?

Study design: Observational. Population: Nonvalvular atrial fibrillation with left atrial thrombus (n=64). Intervention: Heart failure vs. No heart failure. Primary outcome: Persistence of left atrial thrombus (HR 2.72, 95% CI 1.32-5.61, p=0.007).

What question did this study set out to answer?

This study aims to identify predictors influencing left atrial thrombus resolution in atrial fibrillation patients under oral anticoagulation.

March 27, 2015Polskie Archiwum Medycyny WewnętrznejOpen Access

Heart failure as an independent predictor of thrombus persistence in nonvalvular atrial fibrillation: a transesophageal echocardiography‑based study

View Full Paper

Ask AI

Bookmark

Key result

Heart failure was a significant independent predictor of left atrial thrombus persistence in patients with nonvalvular atrial fibrillation receiving oral anticoagulation (HR 2.72).

Why the study?

Does heart failure predict left atrial thrombus persistence in patients with nonvalvular atrial fibrillation receiving oral anticoagulation?

Key Points

This study aims to identify predictors influencing left atrial thrombus resolution in atrial fibrillation patients under oral anticoagulation.
Retrospective analysis of 1877 transesophageal echocardiographic examinations from January 2009 to June 2013.
Included 64 patients with nonvalvular atrial fibrillation and left atrial thrombi, all receiving oral anticoagulation.
Follow-up transesophageal echocardiography performed within a few months after initial diagnosis.
Thrombus resolution occurred in 30 patients (47%) after a mean follow-up of 88 days.
Heart failure was associated with thrombus persistence (HR, 2.72; 95% CI, 1.32-5.61; P = 0.007).
Multivariate analysis indicated heart failure as the only independent predictor of unsuccessful resolution (P = 0.04).

Study Design

Type

Observational (n=64)

Multicenter

Structured PICO

Does heart failure predict left atrial thrombus persistence in patients with nonvalvular atrial fibrillation receiving oral anticoagulation?

Population

64 patients (mean age 64 years, 36% female) with nonvalvular atrial fibrillation and left atrial thrombus receiving oral anticoagulation, followed for a mean of 88 days.

Exposure

Oral anticoagulation with vitamin K antagonist (acenocoumarol, warfarin)

Outcome

Left atrial thrombus resolution on follow-up transesophageal echocardiographysurrogate

Main Result

Hazard Ratio: 2.72 (95% CI 1.32–5.61)

p-value: p=0.007

Heart failure is an independent negative predictor of left atrial thrombus resolution in patients with nonvalvular atrial fibrillation receiving oral anticoagulation.

Limitations

Single-center retrospective analysis with varying duration of follow-up
Lack of additional analysis on the size and echogenicity of the thrombus
Diagnosis of heart failure may be affected by the coexistence of atrial fibrillation
INR was measured only once on the first day of follow-up hospitalization
Did not analyze patients receiving novel oral anticoagulants

Implication

HF predicts LA thrombus persistence on OAC; leaves open whether targeted strategies improve resolution.

Abstract

INTRODUCTION: Formation of left atrial (LA) thrombus is one of the most serious complications in patients with atrial fibrillation (AF). OBJECTIVES: The aim of our study was to determine the predictors of LA thrombus resolution among patients with AF receiving oral anticoagulation. PATIENTS AND METHODS: After a retrospective analysis of 1877 transesophageal echocardiographic examinations (TEEs) performed in our department between January 2009 and June 2013, we included 64 patients (women, 36%; mean age at diagnosis, 64 ±8.8 years) with nonvalvular AF and LA thrombi on TEE into the study. All patients received oral anticoagulation and underwent follow-up TEE within a few months since diagnosis. RESULTS: After a mean follow-up period of 88 ±107 days, thrombus resolution was observed in 30 patients (47%). The univariate Cox proportional regression model showed that heart failure and reduced left ventricular ejection fraction were associated with the persistence of LA thrombus (hazard ratio [HR], 2.72; 95% confidence interval [CI], 1.32-5.61; P = 0.007 and HR, 0.97; 95% CI, 0.94-0.99; P = 0.04; respectively). The international normalized ratio and CHA2DS2-VASc score were not prognostic for thrombus resolution (HR, 0.64; 95% CI, 0.37-1.1; P = 0.1 and HR 1.10; 95% CI, 0.91-1.33; P = 0.3; respectively). In a multivariate analysis, heart failure was the only independent factor predicting unsuccessful resolution of LA thrombus (P = 0.04). CONCLUSIONS: Heart failure is an independent negative predictor of LA thrombus resolution in patients with AF receiving oral anticoagulation.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Kowalczyk et al. (2015) conducted an observational in Nonvalvular atrial fibrillation with left atrial thrombus (n=64). Heart failure vs. No heart failure was evaluated on Persistence of left atrial thrombus (HR 2.72, 95% CI 1.32-5.61, p=0.007). Heart failure was a significant independent predictor of left atrial thrombus persistence in patients with nonvalvular atrial fibrillation receiving oral anticoagulation (HR 2.72).

synapsesocial.com/papers/6a6d6ce126a7f98052db74d5 https://doi.org/10.20452/pamw.2836