Predicting Left Atrial Appendage Thrombus from Left Atrial Volume and Confirmation by Computed Tomography with Delayed Enhancement

Autor: Rine Nakanishi, Matthew J. Budoff, Kazuhiro Osawa, Negin Nezarat, William J. French, Indre Ceponiene
Rok vydání: 2020
Předmět:
Male
medicine.medical_specialty
Heart Diseases
Cardiac Volume
Atrial appendage/diagnostic imaging
Delayed enhancement
030204 cardiovascular system & hematology
030218 nuclear medicine & medical imaging
03 medical and health sciences
0302 clinical medicine
Left atrial
Predictive Value of Tests
Internal medicine
Atrial Fibrillation
Medicine
Humans
Atrial Appendage
cardiovascular diseases
Heart Atria
Prospective Studies
Clinical Investigation
Thrombus
Prospective cohort study
heart atria/diagnostic imaging
multidetector computed tomography/methods
Aged
Body surface area
Appendage
business.industry
risk assessment
Atrial fibrillation
Thrombosis
Odds ratio
thrombosis/diagnosis
Middle Aged
medicine.disease
Cardiovascular System & Hematology
Cardiology
cardiovascular system
Female
Cardiology and Cardiovascular Medicine
business
Tomography
X-Ray Computed
Zdroj: Tex Heart Inst J
Texas Heart Institute journal, vol 47, iss 2
ISSN: 1526-6702
Popis: Assessing thromboembolic risk is crucial for proper management of patients with atrial fibrillation. Left atrial volume is a promising predictor of cardiac thrombosis. To determine whether left atrial volume can predict left atrial appendage thrombus in patients with atrial fibrillation, we conducted a prospective study of 73 patients. Left atrial and ventricular volumes were evaluated by cardiac computed tomography with retrospective electrocardiographic gating and then indexed to body surface area. Left atrial appendage thrombus was confirmed or excluded by cardiac computed tomography with delayed enhancement. Seven patients (9.6%) had left atrial appendage thrombus; 66 (90.4%) did not. Those with thrombus had a significantly higher mean left atrial end-systolic volume index (139 ± 55 vs 101 ± 35 mL/m2; P =0.0097) and mean left atrial end-diastolic volume index (122 ± 45 vs 84 ± 34 mL/m2; P =0.0077). On multivariate logistic regression analysis, left atrial end-systolic volume index (per 10 mL/m2 increase) was significantly associated with left atrial appendage thrombus (odds ratio [OR]=1.24; 95% CI, 1.03–1.50; P =0.02); so too was the left atrial end-diastolic volume index (per 10 mL/m2 increase) (OR=1.29; 95% CI, 1.05–1.60; P =0.02). These findings suggest that increased left atrial volume increases the risk of left atrial appendage thrombus. Therefore, patients with atrial fibrillation and an enlarged left atrium should be considered for cardiac computed tomography with delayed enhancement to confirm whether thrombus is present.
Databáze: OpenAIRE
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