Predictors of left atrial thrombus in acute ischemic stroke patients without atrial fibrillation: A single-center cross-sectional study

Abstract

SUMMARY INTRODUCTION: The present study aimed to determine independent predictors of left atrial thrombus (LAT) in acute ischemic stroke (AIS) patients without atrial fibrillation (AF) using transesophageal echocardiography (TEE). METHODS: In this single-center, retrospective study, we enrolled 149 consecutive AIS patients. All of the patients underwent a TEE examination to detect LAT within 10 days following admission. Multivariate logistic regression analysis was performed to assess independent predictors of LAT. RESULTS: Among all cases, 14 patients (9.3%) had a diagnosis of LAT based on the TEE examination. In a multivariate analysis, elevated mean platelet volume (MPV), low left-ventricle ejection fraction (EF), creatinine, and reduced left-atrium appendix (LAA) peak emptying velocity were independent predictors of LAT. The area under the receiver operating characteristic curve analysis for MPV was 0.70 (95%CI: 0.57-0.83; p = 0.011). With the optimal cut-off value of 9.45, MPV had a sensitivity of 71.4% and a specificity of 63% to predict LAT. CONCLUSION: AIS patients with low ventricle EF and elevated MPV should undergo further TEE examination to verify the possibility of a cardio-embolic source. In addition, this research may provide novel information with respect to the applicability of MPV to predict LAT in such patients without AF.

Prevalence of left atrial appendage thrombus in patients with acute ischaemic stroke and sinus rhythm: a cross-sectional study

“…The prevalence of LAA thrombus in this study was 6.2% (9 of 144 patients). 6 A higher rate (9.3%, 14 of 149 patients) of LAA thrombus was noted in the retrospective study by Cinar et al 5 Our study identified LAA thrombus in 15 of 223 patients (6.7%). These results suggest that it is reasonable to consider the presence of LAA thrombus in cases of newonset ischaemic stroke who exhibit normal sinus rhythm on 12-lead ECG.…”

“…38 39 Limited information is available regarding the predictors of LAA thrombus in patients who had a stroke with baseline sinus rhythm. 5 6 In such patients, while a recent study showed that mean platelet volume, renal function, LVEF and LAA flow velocity were independent predictors of LAA thrombus, 5 another study revealed that LA peak strain and high-sensitivity C reactive protein were associated with LAA thrombus, but not mean platelet volume, renal function or LVEF. 6 In the current study, the adjusted model revealed that patients with SEC had a significantly higher probability of LAA thrombus formation.…”

“…The more recent one was a retrospective study; thus, there may have been selection bias. 5 Therefore, we performed this cross-sectional study aimed at (1) investigating the prevalence of LAA thrombus detected by TEE in patients with acute ischaemic stroke (AIS) and sinus rhythm on 12-lead ECG, (2) screening for paroxysmal AF using 24-hour ECG monitoring and (3) identifying the predictors for LAA thrombus in these patients.…”

“…p=prevalence of LAA thrombus in patients who had a stroke with sinus rhythm (set as 9.3%). 5 The expected rate of exclusion related to patients having AF on 12-lead ECG was 10%; therefore, the required sample size for this study was a minimum of 223 patients.…”

Comment on “Predictors of left atrial thrombus in acute ischemic stroke patients without atrial fibrillation: a single-center cross-sectional study”

“…https://doi.org/10.1590/ 1806-9282.20210463 We are happy to read the article 1 published by Cinar research team. Their findings suggest that patients with acute ischemic stroke with low ventricular ejection fraction and elevated platelet volume should undergo further transespiratory echocardiogram to verify the possibility of myocardial origin.…”