Predictors of left atrium appendage clot detection despite on-target warfarin prevention for atrial fibrillation

Zoppo, Franco; Brandolino, Glauco; Berton, A.; Frigato, Nicoletta; Michieletto, Marco; Zanocco, Albino; Zerbo, Francesca; Bacchiega, Enrico; Lupo, Antonio; Bertaglia, Emanuele

doi:10.1007/s10840-012-9707-0

Cited by 19 publications

(18 citation statements)

References 17 publications

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“…This study has demonstrated a very low prevalence (0.6%) of LA/LAA thrombus in patients undergoing AF ablation. These results are consistent with other studies with similar cohorts of patients (mean age 57–60 years, majority (64–80%) male, all undergoing TOE prior to AF ablation, with similar anticoagulation protocols) who also found thrombus prevalence to be between 0.5% and 2.3% (9, 13, 14). …”

Section: Discussionsupporting

confidence: 91%

Use of the CHA ₂ DS ₂ VASc score to reduce utilisation of transoesophageal echocardiography prior to ablation for atrial fibrillation

et al. 2017

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Transoesophageal echocardiography (TOE) is frequently performed prior to atrial fibrillation (AF) ablation to exclude left atrial appendage (LAA) thrombus. However, patients undergoing AF ablation are usually anticoagulated, thus making the presence of thrombus unlikely in most cases. This study aimed to determine whether the CHA2DS2VASc scoring system can be used to identify patients that do not require TOE prior to AF ablation. In this single-centre retrospective study, local institutional and primary care databases and electronic patient records were searched to identify patients that had undergone TOE prior to AF ablation. Patient demographics, CHA2DS2VASc score, TOE findings and anticoagulation status were collected for analysis. Over a 7-year period (2008–2014), 332 patients (age 57 ± 10 years; 74% male) underwent TOE prior to proposed AF ablation. CHA2DS2VASc scores of 0, 1, 2 and >2 were found in 39, 34, 15 and 12% of patients, respectively. The prevalence of LAA thrombus was 0.6% (2 patients) and these 2 patients had risk scores of 2 and 4. No patients with a score of 0 or 1 had LAA thrombus. Patients that are classed as low risk by the CHA2DS2VASc score do not require a pre-ablation TOE to screen for LAA thrombus provided they are adequately anticoagulated. This would lead to a significant reduction in health care expenditures by reducing unnecessary TOE requests and thereby improve patient experience.

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Section: Discussionsupporting

confidence: 91%

Use of the CHA ₂ DS ₂ VASc score to reduce utilisation of transoesophageal echocardiography prior to ablation for atrial fibrillation

et al. 2017

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“…Similar to the analysis of Gunawardene et al ., high CHADS 2 and CHA 2 DS 2 ‐VASc scores were found to be independent predictors of LAAT in multivariate analysis of previous studies as well . Puwanant et al.…”

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confidence: 71%

“…In the study by Wyrembak et al., no LAAT was found in NOAC treated patients with CHA 2 DS 2 ‐VASc score <5 or in warfarin treated patients with CHA 2 DS 2 ‐VASc score <2 . Zoppo et al . also found in multivariate analysis that a higher CHA 2 DS 2 ‐VASc scores predicted LAAT.…”

mentioning

confidence: 93%

“…5 In the study by Wyrembak et al, no LAAT was found in NOAC treated patients with CHA 2 DS 2 -VASc score <5 or in warfarin treated patients with CHA 2 DS 2 -VASc score <2. 21 Zoppo et al 26 also found in multivariate analysis that a higher CHA 2 DS 2 -VASc scores predicted LAAT. In contrast, Zuo et al 29 have found this association to be in sinus rhythm alone, where the CHA 2 DS 2 -VASc correlated negatively with LAA-flow velocity, and Clark et al 30 could not identify a relationship between either the CHADS 2 or CHA2DS2-VASc scores and LAA velocities.…”

mentioning

confidence: 95%

“…Several studies have found that larger LA diameter (≥4.5 cm) is an independent predictor for LAAT . Akoum et al .…”

mentioning

confidence: 99%

See 2 more Smart Citations

Evaluation of left atrial thrombus prior to catheter ablation of atrial fibrillation: Is it time for an individualized approach?

Laish-Farkash

Suleiman

2017

Cardiovasc electrophysiol

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Association, mutual stabilization, and transcriptional activity of the STRA13 and MSP58 proteins

Ivanova

Ivanov

Lerman

2005

CMLS, Cell. Mol. Life Sci.

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STRA13 is a hypoxia-inducible bHLH transcription factor implicated in the pVHL/HIF, TGF-beta, and Jak/STAT pathways. To further characterize the STRA13 protein-interacting network and mechanisms of STRA13-dependent transcription, we utilized yeast two-hybrid screening. Here we report on STRA13 interaction with the cell cycle-associated transcription factor MSP58. We demonstrated that the basic domain of STRA13 and the FHA domain of MSP58 are essential for this association. We performed phospho-peptide mapping of both MSP58 and STRA13 and showed that their association was modulated by the STRA13 phosphorylation status. STRA13/MSP58 complex formation protected both proteins from the proteasome-mediated degradation, extending their half-lives considerably. STRA13 and MSP58 synergistically co-operated in the STRA13 promoter-driven transcription repression. Both proteins were co-localized in the nucleus and showed transcript accumulation during the S phase of the cell cycle. Thus, we characterize a novel STRA13-associated transcription repression complex and provide a link between cell cycle regulation and STRA13 activity.

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Predictors of left atrium appendage clot detection despite on-target warfarin prevention for atrial fibrillation

Abstract: We found a 2.3 % prevalence of LA thrombus (12.1 % when SEC was also considered). The thrombus was present despite on-target warfarin prevention. In addition to a higher CHA(2)DS(2)VASc score, a larger LA size was a strong predictor of clot detection.

Cited by 19 publications

References 17 publications

Use of the CHA ₂ DS ₂ VASc score to reduce utilisation of transoesophageal echocardiography prior to ablation for atrial fibrillation

Use of the CHA ₂ DS ₂ VASc score to reduce utilisation of transoesophageal echocardiography prior to ablation for atrial fibrillation

Evaluation of left atrial thrombus prior to catheter ablation of atrial fibrillation: Is it time for an individualized approach?

Association, mutual stabilization, and transcriptional activity of the STRA13 and MSP58 proteins

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Predictors of left atrium appendage clot detection despite on-target warfarin prevention for atrial fibrillation

Abstract: We found a 2.3 % prevalence of LA thrombus (12.1 % when SEC was also considered). The thrombus was present despite on-target warfarin prevention. In addition to a higher CHA(2)DS(2)VASc score, a larger LA size was a strong predictor of clot detection.

Cited by 19 publications

References 17 publications

Use of the CHA 2 DS 2 VASc score to reduce utilisation of transoesophageal echocardiography prior to ablation for atrial fibrillation

Use of the CHA 2 DS 2 VASc score to reduce utilisation of transoesophageal echocardiography prior to ablation for atrial fibrillation

Evaluation of left atrial thrombus prior to catheter ablation of atrial fibrillation: Is it time for an individualized approach?

Association, mutual stabilization, and transcriptional activity of the STRA13 and MSP58 proteins

Contact Info

Product

Resources

About

Use of the CHA ₂ DS ₂ VASc score to reduce utilisation of transoesophageal echocardiography prior to ablation for atrial fibrillation

Use of the CHA ₂ DS ₂ VASc score to reduce utilisation of transoesophageal echocardiography prior to ablation for atrial fibrillation