Severe Spontaneous Echo Contrast/Auricolar Thrombosis in “Nonvalvular” AF: Value of Thromboembolic Risk Scores

Mascioli, Giosuè; Lucca, Elena; Michelotti, Federica; Alioto, Giusy; Santoro, Franco; Belli, Guido; Rota, Cristina; Ornago, Ombretta; Sirianni, Giovanni; Pulcini, Emanuela; Pennesi, Matteo; Savasta, Carlo; Russo, R; Pitì, Antonino

doi:10.1111/pace.12958

Cited by 8 publications

(3 citation statements)

References 22 publications

(36 reference statements)

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“…However, it is still controversial whether the CHADS2/ CHA2DS2-VASc score is an independent risk factor for LAT/SEC. Several studies showed the score was not an independent risk factor for LAT/SEC [11,19,22], and had a modest value for predicting LAT/SEC in most studies [12,20,22,23]. These discrepancies might be due to the following reasons: (1) the development of LAT/SEC is closely associated with the matrix and function of the left atrium [24,25], which has different associations with the components of the CHADS2/CHA2DS2-VASc score.…”

Section: Discussionmentioning

confidence: 90%

Association of Thromboembolic Risk Score with Left Atrial Thrombus and Spontaneous Echocardiographic Contrast in Non-Anticoagulated Nonvalvular Atrial Fibrillation Patients

et al. 2018

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Objectives: The aim of the study was to examine the association of CHADS2/CHA2DS2-VASc scores with left atrial thrombus (LAT) and spontaneous echocardiographic contrast (SEC) in non-anticoagulated nonvalvular atrial fibrillation (NVAF) spontaneous patients, and to develop a new scoring system for LAT/SEC prediction. Methods: Consecutive non-anticoagulated NVAF patients with or without LAT/SEC by transesophageal echocardiography were identified in the Guangdong General Hospital. Results: Among 2,173 patients, the prevalence of LAT/SEC was 4.9%. Both predictive values of CHADS2 and CHA2DS2-VASc scores for the presence of LAT/SEC were low-to-moderate (receiver operating characteristic [ROC] = 0.591 and 0.608, respectively, p = 0.90). By multivariate analysis, non-paroxysmal AF, decreased left ventricular ejection fraction, and left atrial enlargement were positively associated with LAT/SEC, while CHADS2/CHA2DS2VASc scores were not. A new scoring system based on these 3 factors above significantly improved the discrimination for LAT/SEC (ROC = 0.792). Conclusions: CHADS2/CHA2DS2-VASc scores had limited value in predicting LAT/SEC; a new scoring system that combines AF type and echocardiographic parameters may better predict LAT/SEC as a surrogate for cardioembolic risk in NVAF patients.

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Section: Discussionmentioning

confidence: 90%

Association of Thromboembolic Risk Score with Left Atrial Thrombus and Spontaneous Echocardiographic Contrast in Non-Anticoagulated Nonvalvular Atrial Fibrillation Patients

et al. 2018

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“…Previous studies have identified several predictive biomarkers for SEC occurrence, such as fibrinogen, C-reactive protein, D-dimer, and some inflammatory biomarkers. 21 36 However, these predictors were obtained by comparing patients with SEC and control, and therefore were not necessarily predictive of SEC severity. The core mechanism for SEC was the aggregation of erythrocytes caused by the compromise of electrostatic repulsion or the formation of intercellular bridging.…”

Section: Discussionmentioning

confidence: 99%

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

Wang

Chen

et al. 2022

Thromb Haemost

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Background Spontaneous echo contrast (SEC) is an important precursor for intracardiac thrombus and stroke. There is very limited data on characteristics of severe SEC and its impact on ischemic risk of NVAF patients after RFCA. Methods Transesophageal echocardiography files were reviewed between March 2009 and March 2021 in this monocentric retrospective study. SEC was classified into four levels. The primary endpoint was thromboembolic event (stroke, myocardial infarction, systemic embolism, and ensuing death), and the secondary endpoint included non-ischemic mortality and recurrent atrial arrhythmia. Results Six hundred SEC cases were enrolled and classified into mild SEC group (Grade 1-2, n=515) and severe SEC Group (Grade 3-4, n=85). Independent risk factors for severe SEC included higher brain natriuretic peptide (BNP), erythrocyte sedimentation rate (ESR), and LAd/∆LVED (LAd=left atrial diameter; ∆LVED= left ventricular end-diastolic diameter-left ventricular end-systolic diameter). Severe SEC group had a higher peri-procedure ischemic event occurrence. (7.1%vs. 1.9%, P=0.007). At a median follow-up of 55 months, severe SEC group had a lower freedom rate from ischemic events (90.1% vs. 75.3%, P<0.001); older age and severe SEC were independent risk factors for ischemic events. In patients undergoing redo-procedure (n=100), a remarkably reduced ESR (17.8±12.0 mm/h vs. 28.2±19.0 mm/h, P<0.001) was observed in patients whose SEC disappeared. Conclusions Higher BNP, ESR, LAd/∆LVED were the independent predictors for severe SEC. Severe SEC were associated with higher peri-procedural and long-term ischemic risks. ESR and LAd/∆LVED, as indicators of hematological and hemodynamic change, seemed helpful in identifying NVAF patients prone to developing severe SEC.

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“…Several surrogate markers based on left atrial dilatation or cardiac function have been proposed for risk stratification of cardiogenic stroke. [15][16][17][18][19][20] However, there has been no study in which those surrogate markers were analyzed in Japanese patients in whom catheter ablation was planned. The aim of this study was to determine simple and practical variables in addition to CHADS2 score that enable prediction of patients at high risk for stroke.…”

Section: Introductionmentioning

confidence: 99%

A novel scoring system for stroke risk stratification in Japanese patients with low CHADS2 scores: Study using a transesophageal‐echocardiogram endpoint

Nagahara

Kamiyama

Fujito

et al. 2020

Journal of Arrhythmia

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Background Catheter ablation is an effective treatment for atrial fibrillation (AF), but it carries risk of perioperative thromboembolism even in cases with low CHADS2 scores. Here, we examined whether a combination of clinical variables can predict stroke risk factors that are assessed by transesophageal echocardiography (TEE). Methods The study population consisted of 209 consecutive AF patients with a CHADS2 score of 0 or 1 (58.7 ± 10.6 years old; persistent AF, 33.0%). All patients underwent TEE, and TEE‐determined stroke risk (TEE risk) was defined as cardiac thrombus/sludge, dense spontaneous echo contrast (SEC), and/or peak left atrial appendage (LAA) flow velocity <0.25 m/s. Results Transesophageal echocardiography risk was observed in 10.5% of the patients. In multivariate logistic analysis, persistent AF [odds ratio (OR): 11.5, CI: 3.14‐42.1, P = .0002], left atrial diameter (LAD) (OR: 1.10, CI: 1.01‐1.20, P = .0293), contrast medium defect (CMD) in the LAA detected by computed tomography (OR: 20.2, CI: 6.3‐65.0, P < .0001), and serum brain natriuretic peptide (BNP) level (OR: 1.00, CI: 1.00‐1.01, P = .0056) were independent predictors of TEE risk. A new scoring system comprising LAD > 41 mm (1 point), BNP > 47 pg/mL (1 point), CMD (2 points), and persistent AF (2 points) was constructed and defined as TEE‐risk score. The area under the curve (AUC) for prediction of TEE risk was 0.631 in modified CHADS2 score and it was 0.852 in TEE‐risk score. Conclusion Transesophageal echocardiography risk is predictable by TEE‐risk score, and its combination with CHADS2 score may improve the stroke risk stratification in AF patients with a low CHADS2 score.

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Severe Spontaneous Echo Contrast/Auricolar Thrombosis in “Nonvalvular” AF: Value of Thromboembolic Risk Scores

Abstract: In patients with persistent AF and suboptimal anticoagulation, a risk score composed by history of heart failure, high CRP, and female gender identifies patients at high risk of left atrial SEC/thrombosis when its value is >1.

Cited by 8 publications

References 22 publications

Association of Thromboembolic Risk Score with Left Atrial Thrombus and Spontaneous Echocardiographic Contrast in Non-Anticoagulated Nonvalvular Atrial Fibrillation Patients

Association of Thromboembolic Risk Score with Left Atrial Thrombus and Spontaneous Echocardiographic Contrast in Non-Anticoagulated Nonvalvular Atrial Fibrillation Patients

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

A novel scoring system for stroke risk stratification in Japanese patients with low CHADS2 scores: Study using a transesophageal‐echocardiogram endpoint

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