Predictors of left atrial thrombi for subsequent thromboembolisms: Risk factors derived from echocardiography.

IF 5.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart rhythm Pub Date : 2025-03-07 DOI:10.1016/j.hrthm.2025.03.164

Tomoki Horie, Shinsuke Miyazaki, Yasutoshi Nagata, Ryoichi Miyazaki, Hirofumi Kujiraoka, Satoshi Hara, Tasuku Yamamoto, Hirofumi Arai, Toshiki Michishita, Ryo Tateishi, Shigeo Shimizu, Shu Yamashita, Moe Mukai, Shinsuke Iwai, Hiroyuki Okada, Akifumi Tanaka, Masahito Suzuki, Emiko Nakashima, Yuichi Ono, Seiji Fukamizu, Yasuteru Yamauchi, Hiroshi Tada, Hitoshi Hachiya, Makoto Suzuki, Koji Azegami, Osamu Inaba, Atsushi Takahashi, Takashi Ashikaga, Tetsuo Sasano

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引用次数: 0

Abstract

Background: Evidence regarding the management of left atrial thrombi (LATs) is limited.

Objectives: We aimed to investigate factors associated with subsequent thromboembolism in patients with LATs and explored potential management approaches.

Methods: This multicenter retrospective study consecutively enrolled patients who underwent morphological assessment of LAT using echocardiography. We evaluated associations between clinical and echocardiographic variables and the occurrence of symptomatic thromboembolism.

Results: Two hundred six patients from 15 centers were enrolled. During follow-up period after echocardiographic diagnosis (651 days; interquartile range 174-1316 days), 19 patients (9.2%) developed thromboembolism. Cox regression analysis identified 3 independent predictors of thromboembolism: LAT maximum length > 20 mm (hazard ratio [HR] 2.63; 95% confidence interval [CI] 1.03-6.68; P=.043), reduced left ventricular ejection fraction (≤40%) (HR 2.95; 95% CI 1.14-7.63; P=.026), and thrombus mobility (HR 3.40; 95% CI 1.27-9.11; P=.015). Patients with ≥2 of these factors (52 [25.2%]) were categorized as the high-risk group, while those with <2 factors (154 [74.8%]) formed the low-risk group. Patients in the high-risk group had a higher incidence of thromboembolism (12 [23.1%] vs 7 [4.5%]; P<.001), despite a higher proportion undergoing urgent surgical thrombectomy (UST; 9 [17.3%] vs 9 [5.8%]; P=.025) compared with the low-risk group. In high-risk patients, UST was associated with a significantly lower rate of adverse outcomes, including all-cause mortality, heart failure hospitalizations, major bleeding, and thromboembolisms, at 90 days (0% vs 35.6%; log-rank, P=.048).

Conclusion: In patients with LATs, large thrombus size, reduced left ventricular ejection fraction, and thrombus mobility were associated with subsequent thromboembolism. UST was associated with fewer adverse clinical outcomes in patients with ≥2 risk factors.

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来源期刊

Heart rhythm 医学-心血管系统

CiteScore

10.50

自引率

5.50%

发文量

1465

审稿时长

24 days

期刊介绍： HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability. HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.