AUTHOR=Kaufmann Damian , Wabich Elżbieta , Kapłon-Cieślicka Agnieszka , Gawałko Monika , Budnik Monika , Uziębło-Życzkowska Beata , Krzesiński Paweł , Starzyk Katarzyna , Wożakowska-Kapłon Beata , Wójcik Maciej , Błaszczyk Robert , Hiczkiewicz Jarosław , Budzianowski Jan , Mizia-Stec Katarzyna , Wybraniec Maciej T. , Kosmalska Katarzyna , Fijałkowski Marcin , Szymańska Anna , Dłużniewski Mirosław , Haberka Maciej , Kucio Michał , Michalski Błażej , Kupczyńska Karolina , Tomaszuk-Kazberuk Anna , Wilk-Śledziewska Katarzyna , Wachnicka-Truty Renata , Koziński Marek , Burchardt Paweł , Daniłowicz-Szymanowicz Ludmiła 

TITLE=Echocardiographic predictors of thrombus in left atrial appendage—The role of novel transthoracic parameters

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.1059111

DOI=10.3389/fcvm.2022.1059111

ISSN=2297-055X

ABSTRACT=Aims. The left atrium appendage thrombus (LAAT) formation is a complex process. A CHA2DS2-VASc scale is an established tool for determining the thromboembolic risk and initiation of anticoagulation treatment in patients with atrial fibrillation or flutter (AF/AFL). We aimed to identify whether any transthoracic echocardiography (TTE) parameters could have an additional impact on LAAT detection. 
Methods and results. That is a sub-study of multicenter, prospective, observational study LATTEE (NCT03591627), which enrolled 3109 consecutive patients with AF/AFL referred for transesophageal echocardiography before cardioversion or ablation. LAAT was diagnosed in 8.0% of patients. The univariate logistic regression analysis (based on pre-specified in the ROC analysis cut-off values with AUC ≥ 0.7) identified left ventricular ejection fraction (LVEF) <= 48% and novel TTE parameters i. e. the ratios of LVEF and left atrial diameter (LAD) <= 1.1 (AUC 0.75; OR 5.64; 95% CI 4.03-7.9; p < 0.001), LVEF to left atrial area (LAA) <= 1.7 (AUC 0.75; OR 5.64; 95% CI 4.02-7.9; p < 0.001), and LVEF to indexed left atrial volume (LAVI) <= 1.1 (AUC 0.75, OR 6.77; 95% CI 4.25-10.8; p < 0.001) as significant predictors of LAAT. In a multivariate logistic regression analysis, LVEF/LAVI and LVEF/LAA maintained statistical significance. Calculating the accuracy of the abovementioned ratios according to the CHA2DS2-VASc scale values revealed their highest predictive power for LAAT in a setting with low thromboembolic risk.
Conclusion. Novel TTE indices could help identify patients with increased probability of the LAAT, with particular applicability for patients at low thromboembolic risk.