Nomogram to Predict Left Atrial Thrombus or Spontaneous Echo Contrast in Patients With Non-valvular Atrial Fibrillation

Abstract

Background: The predictive power of the CHADS2 and CHA2DS2-VASc scores for the presence of Left atrial thrombus (LAT)/ spontaneous echo contrast (SEC) in non-valvular atrial fibrillation (NVAF) is modest. The aim of this analysis is to define clinical and ultrasonic variables associated with LAT/SEC and to propose nomograms for individual risk prediction.Methods: Data on 1,813 consecutive NVAF patients who underwent transesophageal echocardiography (TEE) from January 2016 to January 2021 were collected. The univariate and multivariate logistic regression analyses were used to construct a nomogram. We examined the predictive ability of the risk scores by calculating the area under the curve (AUC). Moreover, the performance of the nomogram was assessed with respect to calibration, discrimination, and clinical usefulness.Results: LAT/SEC was found in 260 (21.0%) and 124 (21.6%) patients in the training and validation cohorts, respectively. On multivariate analysis, independent factors for LAT/SEC were Age, left atrial diameter (LAD), left ventricular ejection fraction (LVEF), hypertension (HTN), previous stroke or transient ischemic attack, Non-paroxysmal AF and a nomogram was built based on these variables. The calibration curve for the probability of LAT/SEC showed good prediction agreement with actual observation. The nomogram achieved good concordance indexes of 0.836 and 0.794 in predicting LAT/SEC in the training and validation cohorts, respectively. Decision curve analysis demonstrated that the nomogram would be clinically useful.Conclusions: In this study, a nomogram was constructed that incorporated six characteristics of NVAF patients. The nomogram may be of great value for the prediction of LAT/SEC in NVAF patients.

Atrial cardiomyopathy markers predict ischemic cerebrovascular events independent of atrial fibrillation in patients with acute myocardial infarction

“…Apparently, reduced flow velocity in the left atrial appendage due to an increase in left atrial volume contributes to stasis and clot formation. This is consistent with transesophageal echocardiographic data which suggest that LAE was an independent risk factor for left atrial thrombus or spontaneous echocardiographic contrast and embolic events ( 31 ). Moreover, our study consolidated the relationship between the LAE and ICVE in AMI patients, and LAE may also represent a potential indication either for initiating or monitoring anticoagulant therapy for the prevention of stroke before the onset of AF in patients with AMI ( 17 ).…”

Development and Validation of a Nomogram for Estimation of Left Atrial Thrombus or Spontaneous Echo Contrast Risk in Non-Valvular Atrial Fibrillation Patients with Low to Borderline CHA2DS2-VASc Score

“…7 Transesophageal Echocardiography Evaluation TEE was performed before catheter ablation or direct current cardioversion for all patients as described in a previous study. 19 Prior to the TEE examination, the details of the procedure were explained for every patient, and all patients provided written informed consent. Thrombus was defined as a circumscribed, uniformly echo dense mass distinct from the underlying left atrial endocardium and pectinate muscles detected in more than 1 imaging plane.…”

Severe Left Atrial Spontaneous Echo Contrast in Nonvalvular Atrial Fibrillation: Clinical Characteristics and Impact on Ischemic Risk Postablation

“…By comparing NVAF patients with and without SEC, previous studies have identified several risk factors for SEC presence, which are capable of reflecting hemodynamic and hematological status correlated with SEC formation, such as HF/decreased LVEF, LA dilation, increased fibrinogen, C-reactive protein, and D-dimer. 10,[29][30][31] Moreover, severe MR was reported to be protective against SEC owing to the increased shear rate within LA. However, it remained unclear if these parameters were suitable to predict severe SEC.…”