Prevalence and predictors of left atrial thrombus in patients with atrial fibrillation: is transesophageal echocardiography necessary before cardioversion?.
Prevalence and predictors of left atrial thrombus in patients with atrial fibrillation: is transesophageal echocardiography necessary before cardioversion?.
- 2015
Available in print through MWHC library: 2002 - present
BACKGROUND: Systemic embolization threatens patients with atrial fibrillation (AF). The risk is enhanced at the time of cardioversion. Transesophageal echocardiography (TEE) prior to cardioversion to screen for left atrial thrombus (LAT), a marker of high risk for embolization, is recommended for many patients with AF. CONCLUSION: LAT is not an uncommon finding of AF patients prior to cardioversion. The current practice of TEE examination may be justified since neither clinical nor routine 2D echo examinations reliably identify LAT.Copyright © 2014. Published by Elsevier Inc. METHODS: Data from 600 consecutive patients with AF undergoing TEE prior to cardioversion for the detection of LAT were analyzed. Clinical, laboratory, and echocardiographic parameters were abstracted from the clinical record. OBJECTIVE: To determine clinical and echocardiographic factors associated with LAT formation in AF. RESULTS: TEE identified LAT in 70 (11.6%) and dense (LA) spontaneous echo contrast (SEC) in 156 (26%). Baseline characteristics and echocardiographic parameters of patients with or without LAT are compared. A prior myocardial infarction, 21 (29.4 %) vs. 31 (5.8), (p < 0.001); hypertension, 60 (85.7%) vs. 386 (72.8), (p 0.02); CHADS(2) > 2, 56 (80%) vs. 308 (58.1%), (p < 0.001) prevalence was higher in patients with LAT. Patients with LAT had lower ejection fraction 38.2 +/- 15.6 vs. 46.2 +/- 14.5, (p < 0.001); higher LA diameter 4.98 +/- 0.7 vs. 4.52 +/- 0.7, (p <0.001); dense LA SEC 44 (62.8) vs. 112 (21.1), (p < 0.001); and low LA appendage emptying velocity 21.7 +/- 12.9 vs. 37.5 +/- 19.4, (p < 0.001). Multivariate analysis was done, and it revealed that low LA emptying velocity had the strongest independent association with LAT (HR 0.89 [CI 0.83-0.96], p value <0.001.
English
1878-0938
*Atrial Fibrillation/th [Therapy]
*Atrial Fibrillation/us [Ultrasonography]
*Echocardiography, Transesophageal
*Electric Countershock
*Thrombosis/us [Ultrasonography]
Aged
Atrial Fibrillation/ep [Epidemiology]
Atrial Fibrillation/pp [Physiopathology]
Female
Humans
Male
Middle Aged
Predictive Value of Tests
Prevalence
Prognosis
Reproducibility of Results
Retrospective Studies
Risk Factors
Thrombosis/ep [Epidemiology]
Thrombosis/pp [Physiopathology]
MedStar Heart & Vascular Institute
Journal Article
Available in print through MWHC library: 2002 - present
BACKGROUND: Systemic embolization threatens patients with atrial fibrillation (AF). The risk is enhanced at the time of cardioversion. Transesophageal echocardiography (TEE) prior to cardioversion to screen for left atrial thrombus (LAT), a marker of high risk for embolization, is recommended for many patients with AF. CONCLUSION: LAT is not an uncommon finding of AF patients prior to cardioversion. The current practice of TEE examination may be justified since neither clinical nor routine 2D echo examinations reliably identify LAT.Copyright © 2014. Published by Elsevier Inc. METHODS: Data from 600 consecutive patients with AF undergoing TEE prior to cardioversion for the detection of LAT were analyzed. Clinical, laboratory, and echocardiographic parameters were abstracted from the clinical record. OBJECTIVE: To determine clinical and echocardiographic factors associated with LAT formation in AF. RESULTS: TEE identified LAT in 70 (11.6%) and dense (LA) spontaneous echo contrast (SEC) in 156 (26%). Baseline characteristics and echocardiographic parameters of patients with or without LAT are compared. A prior myocardial infarction, 21 (29.4 %) vs. 31 (5.8), (p < 0.001); hypertension, 60 (85.7%) vs. 386 (72.8), (p 0.02); CHADS(2) > 2, 56 (80%) vs. 308 (58.1%), (p < 0.001) prevalence was higher in patients with LAT. Patients with LAT had lower ejection fraction 38.2 +/- 15.6 vs. 46.2 +/- 14.5, (p < 0.001); higher LA diameter 4.98 +/- 0.7 vs. 4.52 +/- 0.7, (p <0.001); dense LA SEC 44 (62.8) vs. 112 (21.1), (p < 0.001); and low LA appendage emptying velocity 21.7 +/- 12.9 vs. 37.5 +/- 19.4, (p < 0.001). Multivariate analysis was done, and it revealed that low LA emptying velocity had the strongest independent association with LAT (HR 0.89 [CI 0.83-0.96], p value <0.001.
English
1878-0938
*Atrial Fibrillation/th [Therapy]
*Atrial Fibrillation/us [Ultrasonography]
*Echocardiography, Transesophageal
*Electric Countershock
*Thrombosis/us [Ultrasonography]
Aged
Atrial Fibrillation/ep [Epidemiology]
Atrial Fibrillation/pp [Physiopathology]
Female
Humans
Male
Middle Aged
Predictive Value of Tests
Prevalence
Prognosis
Reproducibility of Results
Retrospective Studies
Risk Factors
Thrombosis/ep [Epidemiology]
Thrombosis/pp [Physiopathology]
MedStar Heart & Vascular Institute
Journal Article