Abstract 15247: Pathophysiologic Correlates of Systolic and Diastolic Dysfunction Predict the Presence of Left Atrial Appendage Thrombus in Patients Undergoing Transesophageal-Guided Electrical Cardioversion for Atrial Fibrillation
Introduction: It remains unclear to what extent reduction in blood flow in the left atrial appendage (LAA) contributes to the risk of ischemic stroke in atrial fibrillation (AF). We sought to identify the predictors of LAA thrombus during transesophageal (TEE)-guided electrical cardioversion (ECV) for non-valvular AF.
Hypothesis: We hypothesized that pathophysiologic correlates of LV systolic (e.g. EF) and diastolic dysfunction [e.g. LAA emptying velocity (LAAEV)] are associated with the development of LAA thrombus in AF.
Methods: We studied 3324 consecutive patients (mean age 69±12.5 years, 66.8% males, followup 4.8±3.6 years) with sustained AF undergoing first-time TEE-guided ECV from our prospective registry between May 2000 and March 2012. Stepwise logistic regression analysis was used to determine the association of clinical risk factors on the occurrence of LAA thrombus. The ROC curve was used to assess the performances of the LAAEV, LV EF in screening for LAA thrombus. Cox regression models were used to identify potential risk factors for ischemic stroke/TIA and mortality.
Results: LAA thrombus was identified in 49 patients (1.5%) during pre-ECV TEE. LAA thrombus occurred more frequently in patients with hypertension (P=.01), cardiomyopathy (P<.001), CHF (P<.001), prior CABG (P=.03), ACE-I or ARB use (P<.001), LA or LAA spontaneous echo contrast (P< .001), and LA thrombus (P< .001). Compared with patients without LAA thrombi, those with thrombi had higher CHA2DS2-VASc score (P=.04), lower LAAEV (P<.001), and lower LVEF (P<.001). Multivariate regression analysis identified LVEF OR (95% CI) 1.04 (1.02-1.06) and LAAEV OR (95% CI) 1.12 (1.08-1.17) as independent predictors of LAA thrombus (c stat .852). A LAAEV cut-point of 20 cm/s was optimal to detect LAA thrombus (sensitivity .75; specificity .77; AUC .82). On followup, LAA thrombus was an independent risk factor for ischemic stroke/TIA, but did not influence survival.
Conclusions: Pathophysiologic correlates of LV systolic and diastolic dysfunction are important risk factors associated with the development of LAA thrombus in patients undergoing TEE-guided ECV for AF. LAA thrombus was independently associated with subsequent ischemic stroke/TIA, but did not significantly influence survival.
Author Disclosures: R.M. Melduni: None. B.J. Gersh: None. P.A. Noseworthy: None. N.M. Ammash: None. W.E. Wysokinski: None. J.K. Oh: None. F.A. Miller: None. K. Chandrasekaran: None. K.R. Bailey: None. C.S. Rihal: None. D.L. Packer: None. J.B. Seward: None. S.J. Asirvatham: None. H. Lee: None.
- © 2016 by American Heart Association, Inc.