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

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

doi:10.3389/fcvm.2022.1059111

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

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

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

INTRODUCTION: 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: That 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.

RESULTS: LAAT 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 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.

Original language	English
Article number	1059111
Number of pages	10
Journal	Frontiers in Cardiovascular Medicine
Volume	9
DOIs	https://doi.org/10.3389/fcvm.2022.1059111
Publication status	Published - 30 Nov 2022

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10.3389/fcvm.2022.1059111Licence: CC BY

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Kaufmann, D., Wabich, E., Kapłon-Cieślicka, A., Gawałko, M., Budnik, M., Uziębło-Życzkowska, B., Krzesiński, P., Starzyk, K., Wożakowska-Kapłon, B., Wójcik, M., Błaszczyk, R., Hiczkiewicz, J., Budzianowski, J., Mizia-Stec, K., Wybraniec, M. T., Kosmalska, K., Fijałkowski, M., Szymańska, A., Dłużniewski, M., ... Daniłowicz-Szymanowicz, L. (2022). Echocardiographic predictors of thrombus in left atrial appendage-The role of novel transthoracic parameters. Frontiers in Cardiovascular Medicine, 9, Article 1059111. https://doi.org/10.3389/fcvm.2022.1059111

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title = "Echocardiographic predictors of thrombus in left atrial appendage-The role of novel transthoracic parameters",

abstract = "INTRODUCTION: 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: That 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.RESULTS: LAAT 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 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.",

author = "Damian Kaufmann and El{\.z}bieta Wabich and Agnieszka Kap{\l}on-Cie{\'s}licka and Monika Gawa{\l}ko and Monika Budnik and Beata Uzi{\c e}b{\l}o-{\.Z}yczkowska and Pawe{\l} Krzesi{\'n}ski and Katarzyna Starzyk and Beata Wo{\.z}akowska-Kap{\l}on and Maciej W{\'o}jcik and Robert B{\l}aszczyk and Jaros{\l}aw Hiczkiewicz and Jan Budzianowski and Katarzyna Mizia-Stec and Wybraniec, {Maciej T} and Katarzyna Kosmalska and Marcin Fija{\l}kowski and Anna Szyma{\'n}ska and Miros{\l}aw D{\l}u{\.z}niewski and Maciej Haberka and Micha{\l} Kucio and B{\l}a{\.z}ej Michalski and Karolina Kupczy{\'n}ska and Anna Tomaszuk-Kazberuk and Katarzyna Wilk-{\'S}ledziewska and Renata Wachnicka-Truty and Marek Kozi{\'n}ski and Pawe{\l} Burchardt and Ludmi{\l}a Dani{\l}owicz-Szymanowicz",

note = "Copyright {\textcopyright} 2022 Kaufmann, Wabich, Kap{\l}on-Cie{\'s}licka, Gawa{\l}ko, Budnik, Uzi{\c e}b{\l}o-{\.Z}yczkowska, Krzesi{\'n}ski, Starzyk, Wo{\.z}akowska-Kap{\l}on, W{\'o}jcik, B{\l}aszczyk, Hiczkiewicz, Budzianowski, Mizia-Stec, Wybraniec, Kosmalska, Fija{\l}kowski, Szyma{\'n}ska, D{\l}u{\.z}niewski, Haberka, Kucio, Michalski, Kupczy{\'n}ska, Tomaszuk-Kazberuk, Wilk-{\'S}ledziewska, Wachnicka-Truty, Kozi{\'n}ski, Burchardt and Dani{\l}owicz-Szymanowicz.",

year = "2022",

month = nov,

day = "30",

doi = "10.3389/fcvm.2022.1059111",

language = "English",

volume = "9",

journal = "Frontiers in Cardiovascular Medicine",

issn = "2297-055X",

publisher = "Frontiers Media S.A.",

}

Kaufmann, D, Wabich, E, Kapłon-Cieślicka, A, Gawałko, M, Budnik, M, Uziębło-Życzkowska, B, Krzesiński, P, Starzyk, K, Wożakowska-Kapłon, B, Wójcik, M, Błaszczyk, R, Hiczkiewicz, J, Budzianowski, J, Mizia-Stec, K, Wybraniec, MT, Kosmalska, K, Fijałkowski, M, Szymańska, A, Dłużniewski, M, Haberka, M, Kucio, M, Michalski, B, Kupczyńska, K, Tomaszuk-Kazberuk, A, Wilk-Śledziewska, K, Wachnicka-Truty, R, Koziński, M, Burchardt, P & Daniłowicz-Szymanowicz, L 2022, 'Echocardiographic predictors of thrombus in left atrial appendage-The role of novel transthoracic parameters', Frontiers in Cardiovascular Medicine, vol. 9, 1059111. https://doi.org/10.3389/fcvm.2022.1059111

TY - JOUR

T1 - Echocardiographic predictors of thrombus in left atrial appendage-The role of novel transthoracic parameters

AU - Kaufmann, Damian

AU - Wabich, Elżbieta

AU - Kapłon-Cieślicka, Agnieszka

AU - Gawałko, Monika

AU - Budnik, Monika

AU - Uziębło-Życzkowska, Beata

AU - Krzesiński, Paweł

AU - Starzyk, Katarzyna

AU - Wożakowska-Kapłon, Beata

AU - Wójcik, Maciej

AU - Błaszczyk, Robert

AU - Hiczkiewicz, Jarosław

AU - Budzianowski, Jan

AU - Mizia-Stec, Katarzyna

AU - Wybraniec, Maciej T

AU - Kosmalska, Katarzyna

AU - Fijałkowski, Marcin

AU - Szymańska, Anna

AU - Dłużniewski, Mirosław

AU - Haberka, Maciej

AU - Kucio, Michał

AU - Michalski, Błażej

AU - Kupczyńska, Karolina

AU - Tomaszuk-Kazberuk, Anna

AU - Wilk-Śledziewska, Katarzyna

AU - Wachnicka-Truty, Renata

AU - Koziński, Marek

AU - Burchardt, Paweł

AU - Daniłowicz-Szymanowicz, Ludmiła

N1 - Copyright © 2022 Kaufmann, Wabich, Kapłon-Cieślicka, Gawałko, Budnik, Uziębło-Życzkowska, Krzesiński, Starzyk, Wożakowska-Kapłon, Wójcik, Błaszczyk, Hiczkiewicz, Budzianowski, Mizia-Stec, Wybraniec, Kosmalska, Fijałkowski, Szymańska, Dłużniewski, Haberka, Kucio, Michalski, Kupczyńska, Tomaszuk-Kazberuk, Wilk-Śledziewska, Wachnicka-Truty, Koziński, Burchardt and Daniłowicz-Szymanowicz.

PY - 2022/11/30

Y1 - 2022/11/30

N2 - INTRODUCTION: 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: That 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.RESULTS: LAAT 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 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.

AB - INTRODUCTION: 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: That 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.RESULTS: LAAT 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 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.

U2 - 10.3389/fcvm.2022.1059111

DO - 10.3389/fcvm.2022.1059111

M3 - Article

C2 - 36531733

SN - 2297-055X

VL - 9

JO - Frontiers in Cardiovascular Medicine

JF - Frontiers in Cardiovascular Medicine

M1 - 1059111

ER -