Abstract 14179: Risk Factors for the Left Atrial Appendage Thrombus in Patients Taking Appropriate Oral Anticoagulation With Atrial Fibrillation
Background: Cardiogenic cerebral infarction has been reported despite taking appropriate oral anticoagulation (OAC) in patients with non-valvular atrial fibrillation (AF). They might need additional therapy such as percutaneous left atrial appendage closure. We examined the risk factors for left atrial appendage thrombus (LAAT) in patients during taking appropriate OAC with non-valvular AF.
Method: We retrospectively studied 703 consecutive patients (age 67±11, 488 men, 306 with paroxysmal AF) who take oral anticoagulation (OAC) therapy (392 with warfarin and 311 with direct oral anticoagulants; DOACs) more than one month who underwent transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) prior to cardioversion or catheter ablation for AF. Clinical data, CHADS2, CHADS2-VASc and TTE parameters were evaluated.
Results: LAAT were detected in 57/703 patients (8%) using TEE. Patients with LAAT showed a high rate of warfarin taking [43/392 (11 %) with warfarin v.s. 14 /311 (5%) with DOACs, p=0.002], a high prevalence of persistent AF (n=347, 13% vs. 3%, p<0.0001), larger left atrial dilatation (LAD, n=57, 48mm vs. 42mm, p<0.0001), lower left ventricular ejection fraction (n=57, 51% vs. 60%, p=0.0007), left ventricular hypertrophy (LVH) (n=84, 19% vs. 6%, p<0.0001), higher rate of congestive heart failure (n=147, CHF) (17% vs. 5%, p<0.0001), hypertension (n=369, 12% vs. 3%, p<0.0001) and vascular disease (n=331, 11% vs. 5%, p=0.0049). Meanwhile, age, diabetes mellitus, prior stroke/TIA, sex, type of AF, and taking period of OAC were not related with LAAT. On multivariate analysis, persistent AF (p=0.0002, harard ratio: 4.4, 95%CI 1.9 to 11.9), large LAD (>40mm) (p=0.0020, harard ratio: 4.9, 95%CI 1.7 to 20.6), LVH (p=0.0062, harard ratio: 2.5, 95%CI 1.3 to 4.8), history of CHF (p=0.0169, harard ratio: 2.2, 95%CI 1.2 to 4.1) and hypertension (p=0.0132, hazard ratio: 2.5, 95%CI 1.2 to 5.7) were independently associated with LAAT.
Conclusion: Persistent AF, large LAD, LVH, history of CHF and hypertension might provide additional risk stratification for LAAT in patients during taking appropriate OAC with non-valvular AF.
Author Disclosures: S. Takahashi: None. T. Mine: None. K. Ashida: None. H. Kishima: None. M. Ishihara: None. T. Masuyama: None.
- © 2016 by American Heart Association, Inc.