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. 2024 Dec 28:56:101590.
doi: 10.1016/j.ijcha.2024.101590. eCollection 2025 Feb.

Spontaneous echo contrast in the left atrial appendage is linked to a higher risk of thromboembolic events and mortality in patients with atrial fibrillation

Jan Traub  1   2 , David Hettesheimer  2 , Jule Pinter  1 , Floran Sahiti  1   2 , Georg Fette  3 , Carsten Henneges  2 , Caroline Morbach  1   2 , Sebastian Herrmann  1   4 , Frank Puppe  3 , Anna Frey  1   2 , Stefan Störk  1   2 , Martin Christa  1   2
Affiliations

Spontaneous echo contrast in the left atrial appendage is linked to a higher risk of thromboembolic events and mortality in patients with atrial fibrillation

Jan Traub et al. Int J Cardiol Heart Vasc. .

Abstract

Background: Cardioversion, a rhythm control treatment for atrial fibrillation (AF), requires ruling out cardiac embolic sources, often originating from the left atrial appendage (LAA). Transesophageal echocardiography (TEE) is used for LAA evaluation, but it is invasive and not widely available. This study aimed to identify cardiovascular risk factors linked to LAA abnormalities and predictors of thromboembolic events and all-cause mortality.

Methods: A single-center retrospective analysis included AF patients admitted to the University Hospital Würzburg between 2009 and 2018 undergoing TEE.

Results: Among 2400 AF patients (median age 72; 36 % women), 469 (20 %) had LAA abnormalities: 282 (60 %) had spontaneous echo contrast (SEC), 72 (15 %) had thrombus formation (THR), and 115 (25 %) had both. Predictors of LAA abnormalities included age (OR 1.04; p = 0.002), congestive heart failure (OR 1.70; p = 0.009), diabetes (OR 1.74; p = 0.007), stroke history (OR 3.36; p = 0.001), vascular disease (OR 1.57; p = 0.026), elevated alkaline phosphatase (OR 1.15; p = 0.003), prior VKA intake (OR 1.53; p = 0.002), and DOAC intake (OR 0.57; p = 0.038). SEC with or without THR independently predicted thromboembolic events (HR 1.74, p = 0.031 and HR 1.53, p = 0.006) and all-cause mortality (HR 1.77, p = 0.011 and HR 1.57, p = 0.002), adjusted for cardiovascular risk factors, anticoagulation, and laboratory data.

Conclusions: In AF patients undergoing TEE, SEC, often overlooked in cardioversion decisions, independently predicted thromboembolic events and mortality.

Keywords: Atrial fibrillation; Mortality; Spontaneous echo contract; Thrombus; Transesophageal echocardiography.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Association of left atrial appendage (LAA) abnormalities with thromboembolic events. The Kaplan-Meier plot illustrates the 5-year cumulative incidence for patients with atrial fibrillation undergoing transesophageal echocardiography in subgroups of LAA abnormalities. The four groups represented are: no LAA abnormality (red), spontaneous echo contrast and thrombus formation (SEC and THR; green), spontaneous echo contrast without thrombus formation (SEC, no THR; blue) and thrombus formation without spontaneous echo contrast (THR, no SEC; blue). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Fig. 2
Fig. 2
Association of left atrial appendage (LAA) abnormalities with the probability of dying. The Kaplan-Meier plot illustrates the 5-year survival probabilities for patients with atrial fibrillation undergoing transesophageal echocardiography in subgroups of LAA abnormalities. The four groups represented are: no LAA abnormality (red), spontaneous echo contrast and thrombus formation (SEC and THR; green), spontaneous echo contrast without thrombus formation (SEC, no THR; blue) and thrombus formation without spontaneous echo contrast (THR, no SEC; blue). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
See this image and copyright information in PMC

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