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. 2022 Jul 7;11(14):3965.
doi: 10.3390/jcm11143965.

Left Ventricular Ejection Fraction Can Predict Atrial Thrombosis Even in Non-High-Risk Individuals with Atrial Fibrillation

Petra Angebrandt Belošević  1 , Anton Šmalcelj  2 , Nikola Kos  3 , Krešimir Kordić  3 , Karlo Golubić  2   3
Affiliations

Left Ventricular Ejection Fraction Can Predict Atrial Thrombosis Even in Non-High-Risk Individuals with Atrial Fibrillation

Petra Angebrandt Belošević et al. J Clin Med. .

Abstract

Background—Current guidelines do not recommend routine use of transesophageal echocardiography (TOE) in anticoagulated patients with atrial fibrillation (AF). The aim of our study was to identify predictors for left atrial thrombosis (LAT) in patients with AF that would require TOE despite anticoagulation therapy, using clinical, laboratory and echocardiographic data which are usually obtained in those patients in a real-world setting. Methods—We analyzed data from electronic medical records (EMR) of consecutive AF patients referred to two university hospitals between January 2014 and December 2017 for pulmonary vein isolation (PVI) or direct current cardioversion. The primary endpoint was the presence of left atrial thrombus on TOE. Multivariable and univariable logistic regression models were computed using variables that were significantly different between the LAT and the control groups. Results—A total of 838 patients were included, of whom 132 (15.8%) had LAT. After controlling for other variables, only the left ventricle ejection fraction (LVEF) remained statistically significant with an OR of 0.956 (95% CI 0.934−0.979), p < 0.01. Regression models including LVEF had significantly higher areas under the receiver operating characteristic (ROC) curves, including in subgroups with non-high thromboembolic risk (CHA2DS2-Vasc = 0 or 1), with an area under the curve (AUC) of 0.76 (95% CI 0.71−0.81), p < 0.0001. Conclusions—The LVEF is an independent predictor of LAT, and it might improve thromboembolic risk stratification in future models. LVEF significantly increased the predictive value of the CHA2DS2-Vasc model and was able to identify LAT in non-high-risk patients.

Keywords: atrial fibrillation; ejection fraction; left atrial thrombus; prediction model.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Nightingale plot of relative frequencies of CHA2DS2-Vasc score groups.
Figure 2
Figure 2
Comparison of ROC curves between the CHA2DS2-Vasc model and CHA2DS2-Vasc + LVEF model. The red line denotes the area of 0.5 of a random classifier.
Figure 3
Figure 3
The ROC curve of the univariable LVEF model in patients with CHA2DS2-Vasc < 2.
See this image and copyright information in PMC

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