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Relationship between body mass index and left atrial appendage thrombus in nonvalvular atrial fibrillation

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Abstract

Atrial fibrillation and obesity are two major growing epidemics in the United States and globally. Obese people are at the increased risk of developing atrial fibrillation. The contribution of obesity as an independent risk factor for stroke in the setting of atrial fibrillation remains unclear. We tested the hypothesis that non-valvular atrial fibrillation (NVAF) patients with increased body mass index (BMI) would be at increased risk for the development of left atrial appendage thrombus (LAAT). Consecutive, anticoagulation naïve patients with NVAF referred for a transesophageal echocardiogram (TEE) between January 1, 2007 and October 21, 2009 were approached for study participation. All clinical, laboratory, and TEE measurement data were collected prospectively. Within a group of 400 anticoagulation naïve NVAF patients (mean age 63 ± 15 years, 28 % women; 17 % with LAAT) the prevalence of LAAT was similar across all BMI categories (normal 13 %, overweight 19 %, obese 16 %, morbidly obese 16 %; p = 0.71). Despite a higher CHADS2 score and a higher prevalence of both hypertension and diabetes mellitus, elevated BMI was not an independent predictor of LAAT when analyzed as either a continuous variable, across BMI WHO categories, a dichotomous variable stratified at values above versus below 27 kg/m2, or BMI stratified on atrial fibrillation duration. Despite a higher prevalence of major risk factors for thromboembolism, the prevalence of LAAT was not increased in overweight, obese, and morbidly obese patients.

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Acknowledgment

This work was supported by CR 17896 grant from the Department of Internal Medicine, Mayo Clinic and statistical support was provided by an internal grant from the Mayo Clinic Division of Cardiology. Research support also was funded, in part, by a training grant from the National Institutes of Health, National Heart, Lung and Blood Institute (K12HL83141) in vascular medicine (KPC) and by Mayo Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Divisions of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Kevin P. Cohoon, Robert D. McBane, Naser Ammash & Waldemar E. Wysokinski

  2. Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

    Joshua P. Slusser & Diane E. Grill

  3. Division of Cardiovascular Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA

    Waldemar E. Wysokinski

Authors
  1. Kevin P. Cohoon
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  2. Robert D. McBane
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  3. Naser Ammash
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  4. Joshua P. Slusser
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  5. Diane E. Grill
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  6. Waldemar E. Wysokinski
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Correspondence to Waldemar E. Wysokinski.

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The authors declare that they have no conflict of interest.

Ethical approval

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. Because TEE study represented integral part of clinical diagnostic routine protocol, obtaining informed consent from individuals whom TEE data were used for this study was not required.

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Cohoon, K.P., McBane, R.D., Ammash, N. et al. Relationship between body mass index and left atrial appendage thrombus in nonvalvular atrial fibrillation. J Thromb Thrombolysis 41, 613–618 (2016). https://doi.org/10.1007/s11239-015-1266-7

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  • DOI: https://doi.org/10.1007/s11239-015-1266-7

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