RT Journal Article
SR Electronic
T1 Atrial fibrillation type and renal dysfunction as important predictors of left atrial thrombus
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1310
OP 1315
DO 10.1136/heartjnl-2018-314492
VO 105
IS 17
A1 Agnieszka Kapłon-Cieślicka
A1 Monika Budnik
A1 Monika Gawałko
A1 Michał Peller
A1 Iwona Gorczyca
A1 Anna Michalska
A1 Aldona Babiarz
A1 Aleksandra Bodys
A1 Robert Uliński
A1 Maciej Żochowski
A1 Piotr Scisło
A1 Janusz Kochanowski
A1 Krzysztof J Filipiak
A1 Grzegorz Opolski
YR 2019
UL http://heart.bmj.com/content/105/17/1310.abstract
AB Objective We aimed to identify predictors of left atrial appendage (LAA) thrombus in patients with atrial fibrillation (AF) and to enhance the prognostic value of the CHA2DS2-VASc score.Methods Derivation cohort included 1033 consecutive AF patients referred for catheter ablation or direct current cardioversion, in whom transoesophageal echocardiography (TOE) was performed prior to the procedure. Logistic regression analysis was used to identify predictors of LAA thrombus on TOE. Receiver operating characteristic (ROC) curves were constructed to compare the newly developed score with the CHA2DS2 and CHA2DS2-VASc scores in the derivation and the validation (n=320) cohort.Results On TOE, LAA thrombus was present in 59 (5.7%) patients in the derivation cohort. Aside from variables encompassed by the CHA2DS2-VASc score, LAA thrombus predictors included AF type (persistent/’permanent’ vs paroxysmal) and renal dysfunction. These predictors were incorporated into the CHA2DS2-VASc score. In ROC analysis, area under the curve (AUC) for the new score (CHA2DS2-VASc-RAF score) was significantly higher (0.81) than those for the CHA2DS2 and CHA2DS2-VASc scores (0.71 and 0.70, respectively). In the validation cohort, the CHA2DS2-VASc-RAF score also performed significantly better (AUC of 0.88) than the CHA2DS2 and CHA2DS2-VASc scores (AUC of 0.63 and 0.60, respectively).Conclusion In real-world AF patients with majority on oral anticoagulation, LAA thrombus was found in approximately 6%. Two variables not included in the CHA2DS2-VASc score (AF type and renal dysfunction) proved strong, independent predictors of LAA thrombus and might improve thromboembolic risk stratification.