January 17, 2023Scientific ReportsOpen Access

Left atrial appendage thrombus formation, potential of resolution and association with prognosis in a large real-world cohort

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Why the study?

Comprehensive data on factors influencing left atrial appendage thrombus formation, resolution, and impact on survival are limited.

Does the presence of left atrial appendage thrombus impact long-term survival and what factors predict its resolution in patients with symptomatic atrial fibrillation?

Structured PICO

Does the presence of left atrial appendage thrombus impact long-term survival and what factors predict its resolution in patients with symptomatic atrial fibrillation?

Population

931 patients (450 with left atrial appendage [LAA] thrombi and 481 randomly selected controls without LAA thrombi) drawn from a screened cohort of 7,759 patients with symptomatic ongoing atrial fibrillation on admission.

Intervention

Presence of left atrial appendage (LAA) thrombus

Comparator

Absence of left atrial appendage (LAA) thrombus

Outcome

10-year survival probability and LAA thrombus resolutionhard clinical

In patients with atrial fibrillation, LAA thrombus formation is associated with advanced structural heart disease and significantly reduces 10-year survival, though resolution is possible and predicted by younger age, non-permanent AF, and higher LAA flow velocities.

Implication

LAA thrombus signals poor 10-year survival in AF; leaves open whether resolution improves outcomes.

Abstract

Comprehensive data on factors influencing left atrial appendage (LAA) thrombus formation, resolution and impact on survival are limited. In this single-center, retrospective study 7759 (2010–2015) patients with symptomatic ongoing atrial fibrillation (AF) on admission were screened for LAA thrombi. 450 patients had LAA thrombi. 481 patients without LAA thrombi were randomly selected as controls. We assessed clinical, echocardiographic, laboratory parameters and long-term survival of both groups. Patients with LAA thrombi compared to controls were older, had more strokes, higher CHA 2 DS 2 -VASc scores, worse renal function, less controlled diabetes, advanced heart failure, lower LAA emptying velocities, higher levels of cardiac and inflammatory markers (all p < 0.001). 56.3% of followed-up patients (304) dissolved their LAA thrombi. Chances of thrombus resolution increased with rising LAA flow velocities (OR 1.061, p = 0.022), whereas advanced age (OR 0.950, p < 0.001) and presence of permanent AF (OR 0.354, p < 0.001) decreased chances of thrombus resolution. Presence of LAA thrombi was associated with a markedly reduced 10-year survival probability (31% versus 69%). LAA thrombus formation is promoted by advanced structural heart disease, inflammation, diabetes and impaired renal function. Younger age, non-permanent AF and higher LAA flow velocities were predictors of thrombus resolution. Thrombus formation was associated with poor prognosis.