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Left Atrial Appendage Structural Characteristics Predict Thrombus Formation
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  • Carson Castellani,
  • Yan Gao,
  • Hyun Kim,
  • Colton Thompson,
  • John Ning,
  • Nicole Lohr,
  • AIMEE WELSH,
  • MARCIE BERGER
Carson Castellani
Medical College of Wisconsin
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Yan Gao
Medical College of Wisconsin Division of Biostatistics
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Hyun Kim
Kaiser Permanente Center for Health Research
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Colton Thompson
University of Wisconsin-Madison
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John Ning
Medical College of Wisconsin
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Nicole Lohr
UAB Hospital
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AIMEE WELSH
Medical College of Wisconsin
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MARCIE BERGER
Medical College of Wisconsin

Corresponding Author:[email protected]

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Abstract

Background: Non-valvular atrial fibrillation (NVAF) is a highly prevalent arrhythmia where loss of synchronized atrial contraction increases the risk of intracardiac thrombus particularly within the left atrial appendage (LAA). Anticoagulation is the mainstay of stroke prevention based on the CHA2DS2-VASc score; however, it does not account for LAA structural characteristics. Methods: The research comprises a retrospective matched case-control study of 196 subjects with NVAF who underwent transesophageal echo (TEE). The control group, without thrombus (n=117), was selected from two different groups, both pools had: NVAF and CHA2DS2-VASc score ≥ 3. One group underwent screening TEE prior to Watchman closure device placement from January 2015 to December 2019 (n=74) the second underwent TEE prior to cardioversion from February to October 2014 (n=43). The study group, with thrombus (n=79), included patients with NVAF, TEE study performed between February 2014 and December 2020, and LAA thrombus. The propensity score method was utilized to determine the matched controls while accounting for confounding from prognostic variables resulting in 61 matched pairs included in the analysis data set. LAA ostial area (OA) (calculated from orthogonal measurements 0, 90° or 45, 135°), LAA maximal depth, and peak LAA outflow velocity were measured. Results: Patient characteristics and TEE data were collected (Table [I](#tbl-cap-0001)) and compared using the t-test or chi-square analysis. We observed a lower LAA peak exit velocity in the thrombus group as compared to the control group. Additionally, we found that patients in the thrombus group had smaller LAA OA at 0 and 90 degrees, at 45 and 135 degrees, using largest diameter, as well as using aggregate OA, and smaller maximum LAA depth compared to patients in the control group. Candidate conditional logistic regression models for the outcome of presence of thrombus were evaluated (Table [II](#tbl-cap-0002)). Statistical results from the best-fitting conditional regression model were calculated (Table [III](#tbl-cap-0003)) showing a significant association between aggregate OA and LAA exit velocity with presence of thrombus. Conclusion: Utilizing LAA structural characteristics to predict thrombus formation may help refine current cardioembolic stroke (CES) risk estimation.
07 Mar 2023Submitted to Journal of Cardiovascular Electrophysiology
07 Mar 2023Submission Checks Completed
07 Mar 2023Assigned to Editor
07 Mar 2023Review(s) Completed, Editorial Evaluation Pending
12 Mar 2023Reviewer(s) Assigned
18 Apr 2023Editorial Decision: Revise Minor
10 Jun 20231st Revision Received
13 Jun 2023Submission Checks Completed
13 Jun 2023Assigned to Editor
13 Jun 2023Review(s) Completed, Editorial Evaluation Pending
13 Jun 2023Reviewer(s) Assigned
21 Jun 2023Editorial Decision: Accept