Echocardiographic predictors of thrombus in left atrial appendage-The role of novel transthoracic parameters

IntroductionThe left atrium appendage thrombus (LAAT) formation is a complex process. A CHA(2)DS(2)-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. MethodsThat is a sub-study of multicenter, prospective, observational study LATTEE (NCT03591627), which enrolled 3,109 consecutive patients with AF/AFL referred for transesophageal echocardiography (TEE) before cardioversion or ablation. ResultsLAAT was diagnosed in 8.0% of patients. The univariate logistic regression analysis [based on pre-specified in the receiver operating characteristic (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 CHA(2)DS(2)-VASc scale values revealed their highest predictive power for LAAT in a setting with low thromboembolic risk. ConclusionNovel TTE indices could help identify patients with increased probability of the LAAT, with particular applicability for patients at low thromboembolic risk.