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Left atrial thrombi and spontaneous echo contrast in patients with atrial fibrillation

Systematic analysis of a single-center experience

Linksatriale Thromben und Spontanechokontrastierung bei Patienten mit Vorhofflimmern

Systematische Analyse einer monozentrischen Erfahrung

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Abstract

Background

Atrial fibrillation is associated with a high risk for thromboembolic events. Thrombi in the left atrial appendage and spontaneous echo contrast (SEC) correlate positively with this embolic risk. We studied the laboratory, echocardiographic, and epidemiologic parameters that could predict left atrial thrombi and the intensity of the SEC.

Patients and methods

Between September 2013 and June 2015 we included 372 patients with atrial fibrillation before planned electrical cardioversion (transesophageal-guided strategy) in this study. After assessing the risk of stroke and bleeding (CHA2DS2-VASc and HAS-BLED scores), we measured the concentration of the D-dimer and B-type natriuretic peptide at the time of the transesophageal echocardiography as well as the left atrial volume and the ejection fraction during transthoracic echocardiography.

Results

The ejection fraction and the CHA2DS2-VASc score were identified as independent predictors of both left atrial thrombi and SEC, whereas the left atrial volume could only predict the intensity of SEC. In contrast to the results of other studies, the biomarkers in this study failed to predict the outcome.

Conclusion

Only the echocardiographic and epidemiologic parameters were predictors of left atrial thrombi and SEC intensity, while the studied biomarkers had no predictive power. Using clinical data and transthoracic echocardiography, we can change the therapeutic strategy in high-risk patients.

Zusammenfassung

Hintergrund

Vorhofflimmern ist assoziiert mit einem hohen Risiko für thromboembolische Ereignisse. Linksatriale Thromben und Spontanechokontrastierung (SEC) korrelieren positiv mit diesem embolischen Risiko. Wir untersuchten die laborchemischen, echokardiographischen und epidemiologischen Parameter, die linksatriale Thromben und den Schweregrad der SEC vorhersagen könnten.

Patienten und Methoden

Von September 2013 bis Juni 2015 schlossen wir insgesamt 372 Patienten mit Vorhofflimmern vor geplanter elektrischer Kardioversion (transösophageal gesteuerte Strategie) in die Studie ein. Nach Berechnung des Embolie- und Blutungsrisikos (CHA2DS2-VASc- und HAS-BLED-Score) erfolgte die Bestimmung der D-Dimere und des natriuretischen Peptids vom B-Typ zum Zeitpunkt der transösophagealen Echokardiographie beziehungsweise des linksatrialen Volumens und der Ejektionsfraktion in einer transthorakalen Echokardiographie.

Ergebnisse

Die Ejektionsfraktion und der CHA2DS2-VASc-Score wurden als unabhängige Prädiktoren der linksatrialen Thromben und SEC identifiziert, während das linksatriale Volumen nur den Schweregrad der SEC vorhersagen konnte. Im Gegensatz zu anderen Studien konnten die Biomarker das Outcome nicht vorhersagen.

Schlussfolgerung

Nur die echokardiographischen und epidemiologischen Parameter waren unabhängige Prädiktoren der linksatrialen Thromben und des Schweregrads der SEC, die untersuchten Biomarker wiesen keinen prädiktiven Wert auf. Mithilfe von klinischen Informationen und transthorakaler Echokardiographie können wir die therapeutische Strategie bei Hochrisikopatienten ändern.

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Authors and Affiliations

  1. Clinic for Cardiology, Angiology and Intensive Care, Klinikum Lippe Detmold, Röntgenstr. 18, 32756, Detmold, Germany

    A. G. Bejinariu, D. U. Härtel, J. Brockmeier, R. Oeckinghaus, A. Herzer & U. Tebbe

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  1. A. G. Bejinariu
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  2. D. U. Härtel
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  3. J. Brockmeier
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  4. R. Oeckinghaus
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Correspondence to A. G. Bejinariu.

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Conflict of interest

A.G. Bejinariu, D.U. Härtel, J. Brockmeier, R. Oeckinghaus, A. Herzer, and U. Tebbe state that there are no conflicts of interest.

This article does not include studies with humans or animals performed by any of the authors.

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Bejinariu, A.G., Härtel, D.U., Brockmeier, J. et al. Left atrial thrombi and spontaneous echo contrast in patients with atrial fibrillation. Herz 41, 706–714 (2016). https://doi.org/10.1007/s00059-016-4423-7

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