Short- and long-term outcome of patients with spontaneous echo contrast or thrombus in the left atrial appendage in the era of the direct acting anticoagulants

Abstract

Background Thrombi and spontaneous echo contrast (SEC) in the left atrial appendage (LAA) are associated with thromboembolic events and poor prognosis. There are very few data on long-term outcome, especially with the use of direct acting anticoagulants (DOAC). Methods In this retrospective study, all transoesophageal echocardiographies performed at a tertiary care university hospital from 2015 to 2020 were analyzed. All patients with thrombus or SEC in the LAA were included. Medical history, laboratory, echocardiographic parameters and medication at discharge were documented. The primary endpoint of the study was a composite endpoint (all-cause mortality, non-fatal stroke or transient ischaemic attack [TIA], non-fatal systemic embolization, non-fatal major bleeding and non-fatal myocardial infarction). Results Of a total of 4062 transoesophageal echocardiographies, thrombi were detected in 51 patients (1.2%) and SEC in 251 patients (6.2%). These patients formed the final study cohort (n = 302). During a mean follow-up period of 956 ± 663 days, 87 patients (29%) suffered the primary point. The following baseline characteristics predicted the primary endpoint: age, haemoglobin, a previous coronary artery bypass grafting, dialysis and choice of anticoagulation. Prescription of apixaban at discharge was associated with lower rate of adverse events (hazard ratio 0.564, confidence interval 0.331–0.960; p = 0.035) while prescription of dabigatran was associated with higher rate of adverse events (hazard ratio 3.091, confidence interval 1.506–6.347; p = 0.002). Conclusion Even in the DOAC era, the occurrence of thrombus or SEC in the LAA is associated with a high rate of MACCE. Our study suggests that the choice of DOAC therapy may have an impact on long-term survival. Graphic abstract

A nomogram to predict left atrial appendage thrombus and spontaneous echo contrast in non-valvular atrial fibrillation patients

“…Previous studies showed that LAAT/SEC can occur in about 10–60% of the NVAF patients [ 15 , 19 , 20 ]. Our findings revealed that out of the 387 AF cases, 232 patients had LAAT/SEC.…”

P‐wave parameters and their association with thrombi and spontaneous echo contrast in the left atrial appendage

“…For the thrombus/SEC group, we examined retrospectively all transoesophageal echocardiographies performed between 2015 and 2020. 12 All patients with sinus rhythm, in whom a thrombus or a SEC in the LAA were detected were included in the study. The indications for transoesophageal echocardiography were planned pulmonary vein isolation, in cases of ESUS, and for evaluation of valvular heart diseases, or unclear infections.…”

“…The study population was composed of a thrombus/SEC group and a control group. For the thrombus/SEC group, we examined retrospectively all transoesophageal echocardiographies performed between 2015 and 2020 12 . All patients with sinus rhythm, in whom a thrombus or a SEC in the LAA were detected were included in the study.…”

Current Status of Left Atrial Appendage Thrombus with Atrial Fibrillation

“…The incidence of LAAT varies greatly owing to the patient's condition, and ranges from 1.2% to 22.6%; however, if adding LAA pre-thrombus conditions such as spontaneous echo contrast, the incidence will further increase. [16] Table 1 [16][17][18][19][20][21][22][23][24][25][26][27][28] summarizes the studies on the incidence of LAAT in AF patients. From August 2016 to December 2021, the incidence of LAAT diagnosed by TEE in AF patients at the Zhoupu hospital was 2.12% (23/1,086 cases).…”