TY - JOUR
T1 - Heart failure and the risk of left atrial thrombus formation in patients with atrial fibrillation or atrial flutter
AU - Wybraniec, Maciej T
AU - Mizia-Szubryt, Magdalena
AU - Cichoń, Małgorzata
AU - Wrona-Kolasa, Karolina
AU - Kapłon-Cieślicka, Agnieszka
AU - Gawałko, Monika
AU - Budnik, Monika
AU - Uziębło-Życzkowska, Beata
AU - Krzesiński, Paweł
AU - Starzyk, Katarzyna
AU - Gorczyca-Głowacka, Iwona
AU - Daniłowicz-Szymanowicz, Ludmiła
AU - Kaufmann, Damian
AU - Wójcik, Maciej
AU - Błaszczyk, Robert
AU - Hiczkiewicz, Jarosław
AU - Łojewska, Katarzyna
AU - Kosmalska, Katarzyna
AU - Fijałkowski, Marcin
AU - Szymańska, Anna
AU - Wiktorska, Anna
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 - Mizia-Stec, Katarzyna
N1 - © 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
PY - 2022/12
Y1 - 2022/12
N2 - AIMS: The aim of the study was to evaluate the prevalence of left atrial thrombus (LAT) on transoesophageal echocardiography (TOE) in patients with atrial fibrillation or atrial flutter (AF/AFl) with reference to the presence of heart failure (HF) and its subtypes.METHODS AND RESULTS: The research is a sub-study of the multicentre, prospective, observational Left Atrial Thrombus on Transoesophageal Echocardiography (LATTEE) registry, which comprised 3109 consecutive patients with AF/AFl undergoing TOE prior to direct current cardioversion or catheter ablation. TOE parameters, including presence of LAT, were compared between patients with and without HF and across different subtypes of HF, including HF with preserved (HFpEF), mid-range (HFmrEF), and reduced ejection fraction (HFrEF). HF was diagnosed in 1336 patients (43%). HF patients had higher prevalence of LAT than non-HF patients (12.8% vs. 4.4%; P < 0.001). LAT presence increased with more advanced type of systolic dysfunction (HFpEF vs. HFmrEF vs. HFrEF: 7.4% vs. 10.5% vs. 20.3%; P < 0.001). Univariate analysis revealed that HFrEF (odds ratio [OR] 4.13; 95% confidence interval [95% CI]: 3.13-5.46), but not HFmrEF or HFpEF, was associated with the presence of LAT. Multivariable logistic regression indicated that lower left ventricular ejection fraction (OR per 1%: 0.94; 95% CI 0.93-0.95) was an independent predictor of LAT formation. Receiver operator characteristic analysis showed LVEF ≤48% adequately predicted increased risk of LAT presence (area under the curve [AUC] 0.74; P < 0.0001).CONCLUSION: The diagnosis of HFrEF, but neither HFmrEF nor HFpEF, confers a considerable risk of LAT presence despite widespread utilization of adequate anticoagulation.
AB - AIMS: The aim of the study was to evaluate the prevalence of left atrial thrombus (LAT) on transoesophageal echocardiography (TOE) in patients with atrial fibrillation or atrial flutter (AF/AFl) with reference to the presence of heart failure (HF) and its subtypes.METHODS AND RESULTS: The research is a sub-study of the multicentre, prospective, observational Left Atrial Thrombus on Transoesophageal Echocardiography (LATTEE) registry, which comprised 3109 consecutive patients with AF/AFl undergoing TOE prior to direct current cardioversion or catheter ablation. TOE parameters, including presence of LAT, were compared between patients with and without HF and across different subtypes of HF, including HF with preserved (HFpEF), mid-range (HFmrEF), and reduced ejection fraction (HFrEF). HF was diagnosed in 1336 patients (43%). HF patients had higher prevalence of LAT than non-HF patients (12.8% vs. 4.4%; P < 0.001). LAT presence increased with more advanced type of systolic dysfunction (HFpEF vs. HFmrEF vs. HFrEF: 7.4% vs. 10.5% vs. 20.3%; P < 0.001). Univariate analysis revealed that HFrEF (odds ratio [OR] 4.13; 95% confidence interval [95% CI]: 3.13-5.46), but not HFmrEF or HFpEF, was associated with the presence of LAT. Multivariable logistic regression indicated that lower left ventricular ejection fraction (OR per 1%: 0.94; 95% CI 0.93-0.95) was an independent predictor of LAT formation. Receiver operator characteristic analysis showed LVEF ≤48% adequately predicted increased risk of LAT presence (area under the curve [AUC] 0.74; P < 0.0001).CONCLUSION: The diagnosis of HFrEF, but neither HFmrEF nor HFpEF, confers a considerable risk of LAT presence despite widespread utilization of adequate anticoagulation.
U2 - 10.1002/ehf2.14105
DO - 10.1002/ehf2.14105
M3 - Article
C2 - 36039813
SN - 2055-5822
VL - 9
SP - 4064
EP - 4076
JO - Esc heart failure
JF - Esc heart failure
IS - 6
ER -