Left Ventricular Ejection Fraction Is Associated with the Risk of Thrombus in the Left Atrial Appendage in Patients with Atrial Fibrillation

Abstract

Introduction. Atrial fibrillation (AF) is associated with high risk of ischemic stroke. The most frequent thrombus location in AF is the left atrial appendage (LAA). Transthoracic echocardiography (TTE) is a basic diagnostic examination in patients (pts) with AF. Objectives. To analyse the relations between basic echocardiographic features, well-established stroke risk factors, type of AF, and anticoagulation therapy with the incidence of left atrial appendage thrombus (LAAT). Patients and Methods. The study group consisted of 768 pts with AF (mean age, 63 years), admitted to three high-reference cardiology departments. Five hundred and twenty-three pts were treated with non-vitamin K antagonist oral anticoagulants (NOACs) and 227 (30%) with vitamin K antagonists (VKAs). The subjects underwent TTE and transesophageal echocardiography (TEE) before cardioversion or ablation. Results. LAAT was significantly more frequent in pts with reduced left ventricular ejection fraction (LVEF): in 10.6% (7 pts) with LVEF<40% and in 9.0% (9 pts) with LVEF 40-49%, while only in 5.5% (33 pts) with LVEF>50%. Compared to pts without LAAT, those with LAAT presented with lower LVEF and higher left atrial diameter (LAD). Multivariate logistic regression revealed the following variables as independent predictors of LAAT: previous bleeding, treatment with VKA, and LVEF. Conclusion. LAAT is related to lower LVEF and higher LAD. LVEF is one of the independent predictors of LAAT. Even in the case of adequate anticoagulant therapy, it might be prudent to consider TEE before cardioversion or ablation in patients with low LVEF and LA enlargement, especially in the coexistence of other thromboembolic risk factors.

ELABELA acts as a protective biomarker in patients with atrial fibrillation

“…As shown in Table 1, patients who developed AF were older, had a high body mass index (BMI) tendency, and the AF patients usually had greater left ventricular end-systolic diameter (LVDd), left ventricular end-systolic diameter (LVDs), and left atrium (P<0.05). Consistent with previous reports (12), left ventricular ejection fraction (LVEF) was decreased in AF patients (Table 1). Concerning the concentrations of the biomarkers at baseline, the AF patients had higher levels of neutrophil (NE), creatine kinase MB (CK-MB), urea nitrogen (BUN), creatinine, uric acid, potassium, total bilirubin (TB), direct bilirubin (DB), fibrinogen (Fbg), glycosylated hemoglobin (HbA1c), total triiodothyronine (TT3), and BNP (P<0.05) (Table 1).…”

Difference in left atrial D-dimer level in patients with atrial fibrillation treated with direct oral anticoagulant

“…In this study, low LVEF was a predictor of high LA D-dimer levels. A previous study reported that decreased LVEF led to LA thrombus formation [16,17].…”

A Study of Cardiogenic Stroke Risk in Non-valvular Atrial Fibrillation Patients

“…In our analysis, decreased LVEF was revealed to be a powerful and independent predictor of LAT/LA-SEC formation in AF patients, which means high cardiogenic stroke risk. Previous studies have suggested that incidence of LAT depending on LVEF, and severe LV systolic dysfunction (confirmed by echocardiography) was a strong predictor of stroke (32,33).…”