Key result
In patients with rheumatic atrial fibrillation undergoing open-heart surgery, left atrial thrombus was present in 15.5% of patients and was independently associated with coronary artery disease (OR 6.35).
Why the study?
Left atrial cavity thrombosis in rheumatic AF has not been extensively studied, unlike non-rheumatic AF where left atrial thrombus is predominantly confined to the appendage.
Cross-Sectional (n=530)
No
In patients with rheumatic atrial fibrillation undergoing mitral valve surgery, left atrial thrombus is present in 15.5% of cases and frequently occurs in the left atrial cavity, with risk increased by coronary artery disease, left atrial enlargement, and mitral stenosis.
May inform targeted CAD evaluation in rheumatic AF surgery; cross-sectional data leave causality and screening utility open.
BACKGROUND: Unlike non-rheumatic atrial fibrillation (AF), where left atrial thrombus (LAT) is predominantly confined to the left atrial appendage (LAA), a significant proportion of LAT in rheumatic AF occurs within the left atrial cavity (LAC). However, LAC thrombosis in rheumatic AF has not been extensively studied. This study aimed to evaluate the prevalence of LAT and its subtypes and identify potential predictors of LAT. METHODS: This retrospective study included adult patients with rheumatic AF who underwent open-heart surgery for mitral valvular abnormalities between January 2019 and December 2020. LAT was identified through intraoperative inspection and categorized as either LAC thrombus or LAA thrombus. The prevalence of LAT and its subtypes was calculated, and logistic regression analysis was performed to identify predictors of LAT. RESULTS: A total of 530 patients (mean age: 59.7 ± 9.5 years; male: 29.8%) with a predominance of mitral stenosis (59.6%) were included. LAT was identified in 82 patients (15.5%), including 44 (8.3%) with LAA thrombus and 38 (7.2%) with LAC thrombus. In the multivariable logistic regression model, coronary artery disease (OR: 6.35, 95% CI: 2.79-14.46, p < 0.001), larger left atrial diameter (OR: 1.31 per 10 mm increase, 95% CI: 1.02-1.68, p = 0.03), and moderate-to-severe mitral stenosis (OR: 1.77, 95% CI: 1.00-3.13, p = 0.05) were independently associated with an increased risk of LAT, whereas moderate-to-severe mitral regurgitation was independently associated with a decreased risk of LAT (OR: 0.21, 95% CI: 0.11-0.43, p < 0.001). CONCLUSION: In patients with rheumatic AF undergoing open-heart mitral valve surgery, LAT can be located in either the LAA or LAC. The presence of LAT was independently associated with coronary artery disease, left atrial enlargement, and mitral valvular abnormalities. Timely screening and management of LAT are crucial to mitigate potentially fatal thromboembolic events.
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Cui et al. (2025) conducted a cross-sectional in Rheumatic atrial fibrillation (n=530). Coronary artery disease vs. Absence of coronary artery disease was evaluated on Presence of left atrial thrombus (OR 6.35, 95% CI 2.79-14.46, p=<0.001). In patients with rheumatic atrial fibrillation undergoing open-heart surgery, left atrial thrombus was present in 15.5% of patients and was independently associated with coronary artery disease (OR 6.35).
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