Predictors of Left Atrial Appendage Thrombus

Introduction Transesophageal echocardiography (TEE) is currently performed for detecting left atrial appendage thrombus (LAAT). CHA2DS2–VASc scale is an established tool for determining the thromboembolic risk and initiation of anticoagulation treatment in patients with atrial fibrillation (AF). We aimed to identify whether any clinical findings and transthoracic echocardiography (TTE) parameters could predict LAAT. Methods This is a retrospective study which enrolled 1076 consecutive patients with AF referred for transesophageal echocardiography (TEE) before cardioversion. Clinical parameters evaluated in this study included age, gender, body mass index, smoke, estimated glomerular filtration rate, CHA2DS2–VASc total score and single items. Echocardiographic variables included for analysis were left ventricular ejection fraction (LVEF), left atrial antero–posterior diameter, left atrial diameter index (LADi), left atrial volume, left atrial volume index (LAVi), mitral stenosis and mitral regurgitation and valvular prosthesis. All the above variables were analysed using univariate e multivariate logistic regression to identify predictors of LAAT diagnosed on TEE. Results LAAT was diagnosed in 7.25% of patients. The univariate logistic regression analysis identified age (OR 1.03, CI 1.00–1.05, p=0.018), congestive heart failure (OR 13.50, CI 5.26–34.66, p=0.0001), hypertension (OR 9.98, CI 2.40–41.46, p=0.0001), diabetes (OR 3.26, CI 1.57–6.78, p=0.003), stroke (OR 3.87, CI 1.41–10.068, p=0.02), vascular disease (OR 6.90, CI 3.38–14.09, p=0.0001), CHA2DS2–VASc total score (OR 1.88, CI 1.51–2.32, p=0.0001), left atrial antero–posterior diameter (OR 1.10, CI 1.06–1.14, p=0.0001), LADi (OR 1.08, CI 1.02–1.14, p=0.006), valvular prosthesis (OR 2.1, CI 1.01–4.37, p=0.04) and mitral stenosis (OR 12.57, CI 4.70–33.55, p=0.0001) as significant predictors of LAAT. In a multivariate logistic regression analysis mitral stenosis, CHA2DS2–VASc total score and left atrial antero–posterior diameter maintained statistical significance. Conclusion The presence of LAAT is related to both clinical and echocardiographic variables. Gender was not a predictor of LAAT, as already indicated in the latest ESC guidelines for atrial fibrillation which suggest the use of the CHA2DS2–VA instead of the CHA2DS2–VASc score for initation of anticoagulation therapy. A score that includes clinical and echocardiographic parameters could be useful for predicting the presence of LAAT.