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Wybraniec MT, Mizia‐Szubryt M, Cichoń M, Wrona‐Kolasa K, Kapłon‐Cieślicka A, Gawałko M, Budnik M, Uziębło‐Życzkowska B, Krzesiński P, Starzyk K, Gorczyca‐Głowacka I, Daniłowicz‐Szymanowicz L, Kaufmann D, Wójcik M, Błaszczyk R, Hiczkiewicz J, Łojewska K, Kosmalska K, Fijałkowski M, Szymańska A, Wiktorska A, Haberka M, Kucio M, Michalski B, Kupczyńska K, Tomaszuk‐Kazberuk A, Wilk‐Śledziewska K, Wachnicka‐Truty R, Koziński M, Burchardt P, Mizia‐Stec K. Heart failure and the risk of left atrial thrombus formation in patients with atrial fibrillation or atrial flutter. ESC Heart Fail 2022; 9:4064-4076. [PMID: 36039813 PMCID: PMC9773653 DOI: 10.1002/ehf2.14105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/19/2022] [Accepted: 07/28/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS The aim of the study was to evaluate the prevalence of left atrial thrombus (LAT) on transoesophageal echocardiography (TOE) in patients with atrial fibrillation or atrial flutter (AF/AFl) with reference to the presence of heart failure (HF) and its subtypes. METHODS AND RESULTS The research is a sub-study of the multicentre, prospective, observational Left Atrial Thrombus on Transoesophageal Echocardiography (LATTEE) registry, which comprised 3109 consecutive patients with AF/AFl undergoing TOE prior to direct current cardioversion or catheter ablation. TOE parameters, including presence of LAT, were compared between patients with and without HF and across different subtypes of HF, including HF with preserved (HFpEF), mid-range (HFmrEF), and reduced ejection fraction (HFrEF). HF was diagnosed in 1336 patients (43%). HF patients had higher prevalence of LAT than non-HF patients (12.8% vs. 4.4%; P < 0.001). LAT presence increased with more advanced type of systolic dysfunction (HFpEF vs. HFmrEF vs. HFrEF: 7.4% vs. 10.5% vs. 20.3%; P < 0.001). Univariate analysis revealed that HFrEF (odds ratio [OR] 4.13; 95% confidence interval [95% CI]: 3.13-5.46), but not HFmrEF or HFpEF, was associated with the presence of LAT. Multivariable logistic regression indicated that lower left ventricular ejection fraction (OR per 1%: 0.94; 95% CI 0.93-0.95) was an independent predictor of LAT formation. Receiver operator characteristic analysis showed LVEF ≤48% adequately predicted increased risk of LAT presence (area under the curve [AUC] 0.74; P < 0.0001). CONCLUSION The diagnosis of HFrEF, but neither HFmrEF nor HFpEF, confers a considerable risk of LAT presence despite widespread utilization of adequate anticoagulation.
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Affiliation(s)
- Maciej T. Wybraniec
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,First Department of Cardiology, School of Medicine in KatowiceMedical University of SilesiaKatowicePoland,Members of the European Reference Network on Heart diseases ‐ ERN GUARD‐HEARTAmsterdamNetherlands
| | - Magdalena Mizia‐Szubryt
- First Department of Cardiology, School of Medicine in KatowiceMedical University of SilesiaKatowicePoland
| | - Małgorzata Cichoń
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,First Department of Cardiology, School of Medicine in KatowiceMedical University of SilesiaKatowicePoland
| | - Karolina Wrona‐Kolasa
- First Department of Cardiology, School of Medicine in KatowiceMedical University of SilesiaKatowicePoland
| | - Agnieszka Kapłon‐Cieślicka
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,1st Chair and Department of CardiologyMedical University of WarsawWarsawPoland
| | - Monika Gawałko
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,1st Chair and Department of CardiologyMedical University of WarsawWarsawPoland,Department of CardiologyMaastricht University Medical Centre and Cardiovascular Research Institute MaastrichtMaastrichtThe Netherlands,Institute of Pharmacology, West German Heart and Vascular CentreUniversity of Duisburg‐EssenDuisburgGermany
| | - Monika Budnik
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,1st Chair and Department of CardiologyMedical University of WarsawWarsawPoland
| | | | - Paweł Krzesiński
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,Department of Cardiology and Internal DiseasesMilitary Institute of MedicineWarsawPoland
| | - Katarzyna Starzyk
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre; Collegium MedicumThe Jan Kochanowski UniversityKielcePoland
| | - Iwona Gorczyca‐Głowacka
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre; Collegium MedicumThe Jan Kochanowski UniversityKielcePoland
| | | | - Damian Kaufmann
- Department of Cardiology and ElectrotherapyMedical University of GdańskGdańskPoland
| | - Maciej Wójcik
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,Department of CardiologyMedical University of LublinLublinPoland
| | - Robert Błaszczyk
- Department of CardiologyMedical University of LublinLublinPoland
| | - Jarosław Hiczkiewicz
- Clinical Department of CardiologyNowa Sól Multidisciplinary HospitalNowa SólPoland,University of Zielona GóraZielona GóraPoland
| | - Katarzyna Łojewska
- Clinical Department of CardiologyNowa Sól Multidisciplinary HospitalNowa SólPoland
| | | | - Marcin Fijałkowski
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,1st Department of CardiologyMedical University of GdanskGdańskPoland
| | - Anna Szymańska
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,Department of Heart DiseasesPostgraduate Medical SchoolWarsawPoland
| | - Anna Wiktorska
- Department of Heart DiseasesPostgraduate Medical SchoolWarsawPoland
| | - Maciej Haberka
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,Department of Cardiology, School of Health SciencesMedical University of SilesiaKatowicePoland
| | - Michał Kucio
- Department of Cardiology, School of Health SciencesMedical University of SilesiaKatowicePoland
| | - Błażej Michalski
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,Department of CardiologyMedical University of LódżŁódźPoland
| | - Karolina Kupczyńska
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,Department of CardiologyMedical University of LódżŁódźPoland
| | - Anna Tomaszuk‐Kazberuk
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,Department of CardiologyMedical University of BiałystokBiałystokPoland
| | | | - Renata Wachnicka‐Truty
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,Department of Cardiology and Internal MedicineMedical University of GdańskGdyniaPoland
| | - Marek Koziński
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,Department of Cardiology and Internal MedicineMedical University of GdańskGdyniaPoland
| | - Paweł Burchardt
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,Department of Biology and Lipid DisordersPoznań University of Medical SciencesPoznańPoland
| | - Katarzyna Mizia‐Stec
- ‘Club 30’Polish Cardiac SocietyWarsawPoland,First Department of Cardiology, School of Medicine in KatowiceMedical University of SilesiaKatowicePoland,Members of the European Reference Network on Heart diseases ‐ ERN GUARD‐HEARTAmsterdamNetherlands
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