Risk factors for left atrial thrombus in younger patients (aged < 65 years) with atrial fibrillation or atrial flutter: Data from the multicenter left atrial thrombus on transesophageal echocardiography (LATTEE) registry.
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Uziȩbło-Życzkowska Beata, Kapłon-Cieślicka Agnieszka, Gawałko Monika, Budnik Monika, Starzyk Katarzyna, Wożakowska-Kapłon Beata, Daniłowicz-Szymanowicz Ludmiła, Kaufmann Damian, Wójcik Maciej, Błaszczyk Robert, Hiczkiewicz Jarosław, Łojewska Katarzyna, Mizia-Stec Katarzyna, Wybraniec Maciej, Kosmalska Katarzyna, Fijałkowski Marcin, Szymańska Anna, Gos Aleksandra, Haberka Maciej, Kucio Michał, Michalski Błazej, Kupczyńska Karolina, Tomaszuk-Kazberuk Anna, Wilk-Śledziewska Katarzyna, Wachnicka-Truty Renata, Koziński Marek, Burchardt Paweł, Krzesiński Paweł
Аннотация
METHODS: We conducted a subanalysis of a multicenter, prospective, observational study [the LATTEE registry]. Consecutive AF/AFl patients referred for cardioversion or ablation were enrolled.
RESULTS: Of the 3,109 patients included in the study, 1,276 were under age 65 (41%). Compared to non-LAT patients, those with LAT (n = 76) had higher CHA2DS2-VASc score (p < 0.001), more frequently had non-paroxysmal AF/AFl (p < 0.001), heart failure (p < 0.001), history of diabetes mellitus (p = 0.001), transient ischemic attack (p = 0.04), coronary artery disease (p = 0.02), and chronic kidney disease (p < 0.001). The LAT patients were also more often smokers (p = 0.004) and were more frequently treated with vitamin K antagonists (VKAs) (p < 0.001). Transthoracic echocardiography revealed a higher left atrial area (p < 0.001), lower left ventricular ejection fraction (LVEF) (p < 0.001), and lower value of LA appendage emptying volume in LAT than in non-LAT patients (p < 0.001). LVEF (OR 2.95; 95% CI: 1.32-6.59, p = 0.008), non-paroxysmal AF/AFl (OR 7.1; 95% CI: 2.05-24.63, p = 0.002) and treatment with VKAs (OR 4.92; 95% CI: 2.48-9.75, p < 0.001) were identified as independent predictors of LAT in younger patients.
CONCLUSIONS: Our study, which focused on younger patients with AF/AFl, indicated substantial clinical and echocardiographic differences between participants with and without LAT. In the AF/AFl patients younger than age 65, the independent predictors of LAT included non-paroxysmal AF/AFl, lower LVEF, and treatment with VKAs.