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Risk factors of left atrial thrombus and/or thromboembolism in patients with nonvalvular, nonischemic atrial fibrillation

Authors: Golukhova E.Z., Gromova O.I., Arakelyan M.G., Bulaeva N.I., Zholbaeva A.Z., Mashina T.V., Dzhanketova V.S., Shlyappo M.A.

Company: Bakoulev National Scientific and Practical Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

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Type:  Heart rhythm disorders


DOI: https://doi.org/10.24022/1997-3187-2017-11-3-262-272

For citation: Golukhova E.Z., Gromova O.I., Arakelyan M.G., Bulaeva N.I., Zholbaeva A.Z., Mashina T.V., Dzhanketova V.S., Shlyappo M.A. Risk factors of left atrial thrombus and/or thromboembolism in patients with nonvalvular, nonishemic atrial fibrillation. Kreativnaya Kardiologiya (Creative Cardiology). 2017; 11 (3): 262–72 (in Russ.). DOI: 10.24022/1997-3187-2017-11-3-262-272

Received / Accepted:  June 16, 2017 / June 30, 2017

Keywords: atrial fibrillation left atrium appendage thrombosis insult risk factors CHA2DS2VASc risk score

Full text:  

 

Abstract

Introduction. Atrial fibrillation (AF) is associated with a high risk for thromboembolic events. The CHA2DS2VASc risk scale is very reliable, but has some limitations. Thromboembolism can occasionally occur even in patients with AF with low CHA2DS2VASc score.

Objective. To determine clinical and instrumental parameters, associated with left atrial thrombosis and/or development of thromboembolic complications in patients with nonvalvular atrial fibrillation without concomitant coronary artery disease.

Material and methods. The retrospective analysis included 112 patients with AF who were hospitalized to Bakoulev Center for Cardiovascular Surgery between 2012 and 2015 for radiofrequency ablation (RFA). All patients had proper anticoagulation. All patients underwent transthoracic echocardiography. Contrast-enhanced computed tomography (CT) of LA was performed in 95 (85%) patients with diagnostic of anatomy pulmonary veins connection and definition one of three morphological types of left atrial appendage (LAA). Transesophageal echocardiography (TEE) was performed in 45 (40%) of patients with calculation of LAA blood velocity and identification of spontaneous ECHO contrast. Fifteen (13%) patients had LAA thrombosis by TEE or CT and/or history of thromboembolic (TE) complications (ischemic stroke or TIA).

Results. The following clinical parameters were significantly associated with LAA thrombosis and/or ischemic stroke or TIA in anamnesis: age older than 65 years (RR 2.1; 95% CI 4.5–7.8; p=0.01), chronic AF (ОR 6.13; 95% CI 1.48–25.47; p=0.03) (risk increases proportionally from paroxysmal to permanent type) and 5 points or more CHA2DS2VASc risk score (ОR 8.0; 95% CI 1.03–62.13; p=0.005). The following TEE parameters had predictive value: low LAA flow velosity (<30 cm/s) (RR 2.72; 95% CI 1.03–7.21; p=0.001), the spontaneous ECHO contrast (RR 3.89; 95% CI 1.35–11.19; p=0.03). According to CT the morphological LAA type III had a predictive value (RR 5.8; 95% CI 1.09–30.66; p=0.01).

Сonclusion. Thus, in addition to traditional risk factors, such as CHA2DS2VASc scale, we identified quite reliable risk factors of LA thrombosis and/or TE events, which are: age >65, chronic AF, low LAA blood flow velocity, the phenomenon of spontaneous ECHO contrast at LA and the morphological LAA type III by CT.

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About Authors

  • Golukhova Elena Zelikovna, Dr. Med. Sc., Academician of Russian Academy of Sciences, Head of Department for Noninvasive Arrhythmology and Surgical Treatment of Combined Pathology, orcid.org/0000-0002-6252-0322;
  • Gromova Ol’ga Igorevna, Cand. Med. Sc., Cardiologist, Researcher, orcid.org/0000-0002-5785-3421;
  • Arakelyan Mari Genrikovna, Researcher, Postgraduate, orcid.org/0000-0001-5089-0169;
  • Bulaeva Naida Ibadulaevna, Cand. Biol. Sc., Senior Researcher, orcid.org/0000-0002-5091-0518;
  • Zholbaeva Aygerim Zamirbekovna, Researcher, Postgraduate;
  • Mashina Tat’yana Vasil’evna, Cand. Med. Sc., Senior Researcher;
  • Dzhanketova Violeta Sultanovna, Cand. Med. Sc., Cardiologist, Researcher, orcid.org/0000-0002-9519-9889;
  • Shlyappo Mariya Aleksandrovna, Researcher, Postgraduate, orcid.org/0000-0001-6264-8919

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


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