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Impact of left atrial appendage flow velocity on thrombus resolution and clinical outcomes in patients with atrial fibrillation and silent left atrial thrombi: insights from the LAT study.
Okada, Masato; Inoue, Koichi; Tanaka, Nobuaki; Tanaka, Koji; Hirao, Yuko; Iwakura, Katsuomi; Egami, Yasuyuki; Masuda, Masaharu; Watanabe, Tetsuya; Minamiguchi, Hitoshi; Oka, Takafumi; Hikoso, Shungo; Sunaga, Akihiro; Okada, Katsuki; Nakatani, Daisaku; Sotomi, Yohei; Sakata, Yasushi.
Afiliación
  • Okada M; Cardiovascular Centre, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan.
  • Inoue K; Cardiovascular Centre, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan.
  • Tanaka N; Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan.
  • Tanaka K; Cardiovascular Centre, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan.
  • Hirao Y; Cardiovascular Centre, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan.
  • Iwakura K; Cardiovascular Centre, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan.
  • Egami Y; Cardiovascular Centre, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan.
  • Masuda M; Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan.
  • Watanabe T; Cardiovascular Centre, Kansai Rosai Hospital, Amagasaki, Japan.
  • Minamiguchi H; Division of Cardiology, Osaka General Medical Centre, Osaka, Japan.
  • Oka T; Cardiovascular Division, Osaka Police Hospital, Osaka, Japan.
  • Hikoso S; Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
  • Sunaga A; Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
  • Okada K; Department of Cardiovascular Medicine, Nara Medical University, Nara, Japan.
  • Nakatani D; Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
  • Sotomi Y; Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
  • Sakata Y; Department of Medical Informatics, Osaka University Graduate School of Medicine, Osaka, Japan.
Europace ; 26(5)2024 May 02.
Article en En | MEDLINE | ID: mdl-38691672
ABSTRACT

AIMS:

Blood stasis is crucial in developing left atrial (LA) thrombi. LA appendage peak flow velocity (LAAFV) is a quantitative parameter for estimating thromboembolic risk. However, its impact on LA thrombus resolution and clinical outcomes remains unclear. METHODS AND

RESULTS:

The LAT study was a multicentre observational study investigating patients with atrial fibrillation (AF) and silent LA thrombi detected by transoesophageal echocardiography (TEE). Among 17 436 TEE procedures for patients with AF, 297 patients (1.7%) had silent LA thrombi. Excluding patients without follow-up examinations, we enrolled 169 whose baseline LAAFV was available. Oral anticoagulation use increased from 85.7% at baseline to 97.0% at the final follow-up (P < 0.001). During 1 year, LA thrombus resolution was confirmed in 130 (76.9%) patients within 76 (34-138) days. Conversely, 26 had residual LA thrombi, 8 had thromboembolisms, and 5 required surgical removal. These patients with failed thrombus resolution had lower baseline LAAFV than those with successful resolution (18.0 [15.8-22.0] vs. 22.2 [17.0-35.0], P = 0.003). Despite limited predictive power (area under the curve, 0.659; P = 0.001), LAAFV ≤ 20.0 cm/s (best cut-off) significantly predicted failed LA thrombus resolution, even after adjusting for potential confounders (odds ratio, 2.72; 95% confidence interval, 1.22-6.09; P = 0.015). The incidence of adverse outcomes including ischaemic stroke/systemic embolism, major bleeding, or all-cause death was significantly higher in patients with reduced LAAFV than in those with preserved LAAFV (28.4% vs. 11.6%, log-rank P = 0.005).

CONCLUSION:

Failed LA thrombus resolution was not rare in patients with AF and silent LA thrombi. Reduced LAAFV was associated with failed LA thrombus resolution and adverse clinical outcomes.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Fibrilación Atrial / Trombosis / Ecocardiografía Transesofágica / Apéndice Atrial / Anticoagulantes Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Europace Asunto de la revista: CARDIOLOGIA / FISIOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Japón Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Fibrilación Atrial / Trombosis / Ecocardiografía Transesofágica / Apéndice Atrial / Anticoagulantes Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Europace Asunto de la revista: CARDIOLOGIA / FISIOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Japón Pais de publicación: Reino Unido