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Relations between left atrial appendage contrast retention and thromboembolic risk in patients with atrial fibrillation

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Abstract

Left atrial appendage (LAA), a blind pouch, accounts for more than 90% of the source of cardiac thrombus formation. Contrast retention (CR) in the LAA has been frequently observed during left atrial appendage occlusion (LAAO) procedures, especially in patients with stroke history. This study was designed to assess the relations between LAA contrast retention and thrombogenesis risk of the LAA in patients with non-valvular atrial fibrillation. A total of 132 consecutive patients who underwent LAAO were enrolled. The data collected from computed tomography (CT), transthoracic echocardiography (TTE), transesophageal echocardiography (TEE) and blood samples were analyzed. Univariate and multivariate logistic regression models were constructed to assess the association between CR, left atrial appendage thrombus (LAAT) and other factors. Contrast retention was observed in 33 patients, accounting for 25% of the population. Compared to the non-CR group, patients in the CR group had a larger left atrium anteroposterior diameter (49.64 ± 11.57 vs. 42.42 ± 7.04, P = 0.002), higher CHADS2 (3.88 ± 0.99 vs. 2.97 ± 1.35, P = 0.001) and CHA2DS2-VASc scores (5.79 ± 1.14 vs. 4.89 ± 1.56, P = 0.003), a higher rate of prior stroke (90.9% vs. 66.7%, P = 0.007), more LAA lobes (3.13 ± 1.18 vs. 2.64 ± 1.12, P = 0.038), and a higher prevalence of LAAT (63.6% vs. 13.1%, P < 0.001). After having adjusted the logistic model, only contrast retention, LAA cauliflower morphology and left ventricular ejection fraction (LVEF) were independently associated with LAAT. Patients with LAA contrast retention have a higher risk of left atrial appendage thrombosis. Contrast retention may be a cardiac factor strongly associated with cardiogenic stroke.

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Data availability

Data are available at https://wws.lanzous.com/iKDO9jjiggd.

Abbreviations

AF:

Atrial fibrillation

LAA:

Left atrial appendage

CR:

Contrast retention

LAAO:

Left atrial appendage occlusion

LAAT:

Left atrial appendage thrombus

CHADS2 :

Congestive heart failure, Hypertension, Age > 75, Diabetes mellitus, and prior Stroke or transient ischemic attack

CHA2DS2-VASc:

Congestive heart failure, Hypertension, Age (> 75 = 2 points, 65 to 74 = 1 point, < 65 = 0 point), Diabetes mellitus, prior Stroke or transient ischemic attack, female gender

HAS-BLED:

Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile INRs, Elderly, Drugs or alcohol

TTE:

Transthoracic echocardiography

TEE:

Transesophageal echocardiography

OR:

Odds ratio

CI:

Confidence interval

TIA:

Transient ischemia attack

LAAPD:

Left atria anteroposterior diameter

CFD:

Contrast filling defect

ROC:

Operating characteristic curve

AUC:

Area under the curve

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Acknowledgements

We gratefully acknowledge the neurologist in our hospital for assistance in confirming cardiogenic stroke diagnosis.

Funding

This work was supported by the National Key Research and Development Project of China (grant number 2018YFCZ001200).

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Author notes

  1. Xu Lu and Tao Chen contributed equally and are co-first authors of this article.

Authors and Affiliations

  1. Medical School of Chinese PLA, 28 Fuxing Road, Haidian District, Beijing, 100853, China

    Xu Lu

  2. Department of Cardiology, the Sixth Medical Centre, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China

    Xu Lu, Tao Chen, Ge Liu, Yutao Guo, Xiangmin Shi, Yundai Chen, Yang Li & Jun Guo

  3. Outpatient Department, The 44th Sanatorium of Retired Cadres in Haidian District, No. 19 Dahuisi Road, Beijing, 100081, China

    Xu Lu

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Contributions

XL collected the data, performed statistical analyses and drafted the manuscript; TC collected data and revised the manuscript; GL and XS participated in collect the data, YC and YC revised the manuscript; YL participated in designing the study and revised the manuscript; JG designed the study, the analyses and revised the manuscript.

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Correspondence to Yang Li or Jun Guo.

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All the authors declare that they have no conflict of interest.

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The study protocol was approved by the Research Ethics Committee of the Chinese People’s Liberation Army General Hospital. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Given the observational and retrospective nature of this study, no additional informed consent was required, and the privacy of all patients was fully secured.

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Lu, X., Chen, T., Liu, G. et al. Relations between left atrial appendage contrast retention and thromboembolic risk in patients with atrial fibrillation. J Thromb Thrombolysis 53, 191–201 (2022). https://doi.org/10.1007/s11239-021-02490-8

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