Predictors of left atrial appendage thrombus despite NOAC use in nonvalvular atrial fibrillation and flutter.

Autor: Shah M; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America. Electronic address: maulin.shah@cshs.org., Mobaligh N; University of Nevada, Reno School of Medicine, Reno, NV, United States of America., Niku A; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America., Shiota T; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America. Electronic address: takahiro.shiota@cshs.org., Siegel RJ; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America. Electronic address: Robert.siegel@cshs.org., Rader F; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America. Electronic address: Florian.Rader@cshs.org.
Jazyk: angličtina
Zdroj: International journal of cardiology [Int J Cardiol] 2020 Oct 15; Vol. 317, pp. 86-90. Date of Electronic Publication: 2020 Apr 25.
DOI: 10.1016/j.ijcard.2020.04.070
Abstrakt: Objective: A small but significant proportion of patients with atrial fibrillation or atrial flutter (AF) develop left atrial appendage thrombus (LAAT) despite non-vitamin K antagonist oral anticoagulant (NOAC) prescription. This study examines clinical and echocardiographic risk factors associated with LAAT by transesophageal echocardiogram (TEE) despite NOAC use in patients with non-valvular AF, to inform the decision whether a TEE should be performed prior to cardioversion.
Methods: We compared clinical and echocardiographic characteristics of patients with LAAT despite NOAC prescription for >3 weeks (n = 38) with a consecutive sample of patients on NOAC without LAAT (n = 101).
Results: The prevalence of LAAT despite NOAC prescription was 2.6%. Left atrial dilation (adjusted odds ratio [aOR] 3.310, 95% CI 1.144-9.580, p = 0.02) and greater CHA 2 DS 2 -VASC score (per-point increase, aOR 1.293, 1.027-1.628, p = 0.03) increased the odds for LAAT. Higher LVEF (per 5%, aOR 0.834, 0.704-0.987, p = 0.03) and presence of severe mitral regurgitation (aOR 0.147, 0.048-0.446, p = 0.002) were protective against LAAT. LAA emptying velocities were also independently associated with presence of LAAT (aOR per 10 cm/s, 0.46, 0.27-0.77).
Conclusion: Left atrial dilation, greater CHA 2 DS 2 -VASC score, absence of severe mitral regurgitation and lower left ventricular ejection fraction are associated with LAAT despite NOAC therapy. In addition to suspected NOAC noncompliance, presence of such high-risk features may warrant pre-cardioversion TEE. Similarly, in patients with LVEF > 50% and CHA 2 DS 2 -VASC < 2, risk of LAAT was exceedingly low and thus TEE before cardioversion is low-yield.
Competing Interests: Declaration of competing interest The authors report no relationships that could be construed as a conflict of interest.
(Copyright © 2020 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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