General thoracic and cardiovascular surgery · 2025
Analysis of risk factors for left atrial appendage thrombus formation in patients with atrial fibrillation.
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Nishimura Masanori, Yano Mitsuhiro, Yokota Atsuko, Sakurahara Daichi, Nishino Shun, Nishino Chiharu, Shibata Yoshisato, Asada Yujiro, Hatakeyama Kinta
Аннотация
OBJECTIVE: To identify predictors of left atrial appendage thrombus formation.
METHODS: We retrospectively analyzed 149 patients with persistent or paroxysmal atrial fibrillation who underwent cardiovascular surgery between January 2015 and October 2023. Resected left atrial appendages were histologically evaluated for thrombus and amyloid deposition. After excluding 11 patients with transthyretin-type amyloids and 10 with rheumatic mitral valve stenosis, 128 patients (median age, 72.0 years; range, 37-84 years) were assessed. Patients were categorized into the thrombus and no-thrombus groups. Clinical data, echocardiographic findings, and atrial natriuretic peptide amyloid grades (0-3) were compared.
RESULTS: Fresh or organized thrombi and atrial natriuretic peptide amyloid deposition were observed in 28 (21.9%) and 110 (85.9%) patients, respectively. Moderate or greater aortic stenosis was more frequent in the thrombus group (p = 0.004). Although overall atrial natriuretic peptide amyloid deposition rates were similar (p = 0.377), amyloid deposition degree was significantly greater in the thrombus group (p < 0.001). Multivariate logistic regression identified moderate or greater aortic stenosis and amyloid deposition degree as independent predictors, whereas moderate or greater mitral regurgitation was a negative predictor.
CONCLUSIONS: Moderate or greater aortic stenosis and atrial natriuretic peptide amyloid deposition degree predicted left atrial appendage thrombus formation, whereas moderate or greater mitral regurgitation was a negative predictor.
METHODS: We retrospectively analyzed 149 patients with persistent or paroxysmal atrial fibrillation who underwent cardiovascular surgery between January 2015 and October 2023. Resected left atrial appendages were histologically evaluated for thrombus and amyloid deposition. After excluding 11 patients with transthyretin-type amyloids and 10 with rheumatic mitral valve stenosis, 128 patients (median age, 72.0 years; range, 37-84 years) were assessed. Patients were categorized into the thrombus and no-thrombus groups. Clinical data, echocardiographic findings, and atrial natriuretic peptide amyloid grades (0-3) were compared.
RESULTS: Fresh or organized thrombi and atrial natriuretic peptide amyloid deposition were observed in 28 (21.9%) and 110 (85.9%) patients, respectively. Moderate or greater aortic stenosis was more frequent in the thrombus group (p = 0.004). Although overall atrial natriuretic peptide amyloid deposition rates were similar (p = 0.377), amyloid deposition degree was significantly greater in the thrombus group (p < 0.001). Multivariate logistic regression identified moderate or greater aortic stenosis and amyloid deposition degree as independent predictors, whereas moderate or greater mitral regurgitation was a negative predictor.
CONCLUSIONS: Moderate or greater aortic stenosis and atrial natriuretic peptide amyloid deposition degree predicted left atrial appendage thrombus formation, whereas moderate or greater mitral regurgitation was a negative predictor.