Spontaneous echo contrast in left atrial appendage during sinus rhythm.
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ABSTRACT:
SUBMITTER: Siddiqui MA
PROVIDER: S-EPMC101214 | biostudies-literature | 2001
REPOSITORIES: biostudies-literature
Publications
Spontaneous echo contrast in left atrial appendage during sinus rhythm.
Siddiqui M A MA Holmberg M J MJ Khan I A IA
Texas Heart Institute journal 20010101 4
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Project description:Objectives: Spontaneous echo contrast (SEC) in the left atrium (LA) is frequently observed in atrial fibrillation (AF) patients and may lead to thromboembolic events. We aimed to investigate both periprocedural and long-term stroke risks associated with LA SEC in AF patients undergoing percutaneous left atrial appendage closure (LAAC). Methods: A total of 408 consecutive AF patients treated with LAAC between March 2015 and February 2019 were divided into two groups based on preprocedural transesophageal echocardiography: the study group (moderate/severe LA SEC; n = 41) and the control group (none, mild, or mild to moderate LA SEC; n = 367). To attenuate the observed imbalance in baseline covariates, a propensity score matching technique was used. Results: No periprocedural stroke/transient ischemic attack (TIA) was documented. The incidence of device-related thrombus was higher in the study group than in the control group (8.8 vs. 1.3%; P = 0.025). The mean follow-up period was 3.2 ± 1.1 years, during which 8 patients (2.2%) in the control group and 4 (9.8%) in the study group experienced stroke/TIA (P = 0.024). Moderate/severe LA SEC was identified as an independent predictor of stroke/TIA in both the original population (HR = 5.71, 95% CI 1.47-22.19, P = 0.012) and the matched population (HR = 9.79, 95% CI 1.44-66.86, P = 0.020). Conclusions: LA SEC did not show a relationship with periprocedural stroke events in patients undergoing percutaneous LAAC. However, moderate/severe LA SEC increased the incidence of device-related thrombus and the risk of late stroke/TIA.
| S-EPMC8495018 | biostudies-literature
Project description:Left atrial appendage (LAA) is a well-known source of focal atrial tachycardias (AT). Although radio-frequency (RF) energy is the most commonly used technique in such cases, there was an option other than epicardial approach when RF technique fails. Cryoballoon technology is primarily developed to be used for pulmonary vein isolation (PVI). Also, there was no report regarding the isolation of LAA by using cryo-balloon in patients with focal AT. In this case, for the first time in the literature, we successfully isolated the LAA because of failed attempts of RF ablation for focal AT in whom the surface electrogram showed a sinus rhythm while arrhythmia continues inside the LAA.
| S-EPMC5784686 | biostudies-other
Project description:BackgroundAtrial fibrillation (AF) is one of the most frequently encountered arrhythmias in clinical practice, with stroke triggered by detachment of left atrial appendage thrombus (LAAT) after AF being its most critical complication. The purpose of this study was to construct a nomogram model for forecasting left atrial appendage (LAA) dense spontaneous echo contrast (SEC) and LAAT to accurately identify patients at high risk for stroke.MethodsA retrospective analysis was conducted on 433 patients with AF receiving transesophageal echocardiography (TEE) in the First Affiliated Hospital of Soochow University from October 2019 to July 2022. These patients were assigned into a non-dense SEC/LAAT group or a dense SEC/LAAT group. We constructed a nomogram model dependent on the odds ratios (ORs) of logistic regression and subsequently compared its performance with two models, CHADS2 and CHA2DS2-VASc.ResultsFemale gender, high D-dimer level, low left ventricular ejection fraction, low left atrial ejection fraction, and low left atrial reservoir strain rate were found to be independent factors for predicting LAA SEC/LAAT, with OR values and 95% confidence intervals of 2.811 (1.445-5.469), 2.460 (1.230-4.921), 0.961 (0.927-0.996), 0.950 (0.932-0.967), and 0.173 (0.035-0.848), respectively. The consistency statistic of the nomogram based on these given predictive factors was 0.921, and the calibrated consistency statistic was 0.903. According to receiver operation curve analysis and decision curve analysis, the nomogram was demonstrated to be superior to the CHADS2 and CHA2DS2-VASc models in predicting LAA dense SEC/LAAT. The net reclassification improvement and integrated discrimination improvement of the nomogram were 0.449 (0.324-0.575) and 0.461 (0.408-0.515), when compared with the CHADS2 model, and were 0.521 (0.411-0.632), and 0.432 (0.400-0.504), respectively, when compared with the CHA2DS2-VASc models.ConclusionsThe nomogram model constructed in this study demonstrated excellent performance in predicting LAA dense SEC/LAAT, displaying a superior ability to that of the CHADS2 and CHA2DS2-VASc models.
| S-EPMC11009604 | biostudies-literature
Project description:BackgroundInterventional left atrial appendage occlusion (LAAO) provides an alternative to oral anticoagulation (OAC) for prophylaxis of thromboembolic events (TEs) in nonvalvular atrial fibrillation patients, predominantly in those with high bleeding risk and contraindications for long-term OAC. Although spontaneous echo contrast (SEC) is a well-known risk factor for atrial thrombus formation, little is known about whether this means an increased risk of device-related thrombus (DRT) or TEs following LAAO.MethodsThis substudy of the prospective, multicenter German LAARGE registry assessed two groups according to absence (SEC -) or presence of SEC (SEC +) in preprocedural cardiac imaging. Clinical and echocardiographic parameters were registered up to 1 year after LAAO.ResultsFive hundred eighty-eight patients (SEC - 85.5 vs. SEC + 14.5%) were included. More SEC + patients were implanted for OAC non-compliance (11.8 vs. 4.6%, p = 0.008) and a higher proportion received only antiplatelet therapy without OAC at hospital discharge (96.5 vs. 86.0%, p = 0.007). The SEC + patients had larger LA diameters (50 (47; 54) vs. 47 (43; 51) mm, p < 0.001), wider LAA ostia (21 (19; 23) vs. 20 (17; 22) mm at 45°, p = 0.011), and lower left ventricular ejection fraction (50 (45; 60) vs. 60 (50; 60) %, p < 0.001) on admission. Procedural success was very high in both groups (98.1%, p = 1.00). Periprocedural major adverse cardiac and cerebrovascular events and other major complications were rare in both groups (3.8 vs. 4.7%, p = 0.76). At follow-up, DRT was only detected in the SEC - group (3.8 vs. 0%, p = 1.00). The rates of TEs (SEC - 1.2 vs. SEC + 0%, p = 1.00) after hospital discharge and 1-year mortality (SEC - 12.0 vs. SEC + 11.8%, p = 0.96) were not significantly different between the two groups.ConclusionsPresence of SEC at baseline was not associated with an increased rate of DRT or TEs at 1-year follow-up after LAAO in LAARGE.
| S-EPMC10770218 | biostudies-literature
Project description:BackgroundThrombi and spontaneous echo contrast (SEC) in the left atrial appendage (LAA) are associated with thromboembolic events and poor prognosis. There are very few data on long-term outcome, especially with the use of direct acting anticoagulants (DOAC).MethodsIn this retrospective study, all transoesophageal echocardiographies performed at a tertiary care university hospital from 2015 to 2020 were analyzed. All patients with thrombus or SEC in the LAA were included. Medical history, laboratory, echocardiographic parameters and medication at discharge were documented. The primary endpoint of the study was a composite endpoint (all-cause mortality, non-fatal stroke or transient ischaemic attack [TIA], non-fatal systemic embolization, non-fatal major bleeding and non-fatal myocardial infarction).ResultsOf a total of 4062 transoesophageal echocardiographies, thrombi were detected in 51 patients (1.2%) and SEC in 251 patients (6.2%). These patients formed the final study cohort (n = 302). During a mean follow-up period of 956 ± 663 days, 87 patients (29%) suffered the primary point. The following baseline characteristics predicted the primary endpoint: age, haemoglobin, a previous coronary artery bypass grafting, dialysis and choice of anticoagulation. Prescription of apixaban at discharge was associated with lower rate of adverse events (hazard ratio 0.564, confidence interval 0.331-0.960; p = 0.035) while prescription of dabigatran was associated with higher rate of adverse events (hazard ratio 3.091, confidence interval 1.506-6.347; p = 0.002).ConclusionEven in the DOAC era, the occurrence of thrombus or SEC in the LAA is associated with a high rate of MACCE. Our study suggests that the choice of DOAC therapy may have an impact on long-term survival.
| S-EPMC8563546 | biostudies-literature
Project description: Not available
| S-EPMC8283536 | biostudies-literature
Project description:BackgroundPericardial effusion is a common complication of percutaneous left atrial appendage (LAA) closure. Acute management is the cornerstone of pericardial effusion treatment and interrupting the intervention is often required.Case summaryA 65-year-old man presented an acute 10 mm pericardial effusion following pigtail contrast appendage injection. A rapid Watchman Flex 24 mm (Boston Scientific) deployment permitted bleeding interruption. A needle pericardiocentesis was achieved in order to prevent any haemodynamical instability.DiscussionThis case report describes an atypical cause of pericardial effusion and a technique for bleeding control with LAA closure device deployment.
| S-EPMC8183657 | biostudies-literature
Project description:ObjectiveTo investigate the risk factors of left atrial thrombus (LAT)/spontaneous echo contrast (SEC) in patients with nonvalvular atrial fibrillation (AF).MethodsThis retrospective study analysed the data from consecutive patients with nonvalvular AF that underwent transoesophageal echocardiography. Logistic regression analysis was performed to identify risk factors of LAT/SEC. Receiver operating characteristic curve analysis was undertaken compare the new scales with CHADS2 and CHA2DS2-VASc scores.ResultsA total of 558 patients with AF were included in the study. LAT/SEC was detected in 137 (24.6%) patients. The independent risk factors of LAT/SEC beyond CHADS2 or CHA2DS2-VASc scores included non-paroxysmal AF and left atrial diameter >37.5 mm. These two variables were added into the CHADS2 or CHA2DS2-VASc score to build new scales. Areas under the curve for the new scales based on CHADS2 and CHA2DS2-VASc scores were significantly higher than the CHADS2 or CHA2DS2-VASc score both in the overall study cohort and in patients at a high risk of thromboembolism.ConclusionsNon-paroxysmal AF and increased left atrial diameter beyond the CHADS2 or CHA2DS2-VASc score were independent risk factors of LAT/SEC and may help to improve the current risk stratification, especially for patients with nonvalvular AF at a high risk of thromboembolism.
| S-EPMC8883313 | biostudies-literature
Project description:The intensity of left atrial spontaneous echo contrast (LASEC) by transesophageal echocardiography (TEE) has been proposed as an important variable in the stratification of thromboembolic risk, particularly in patients with nonvalvular atrial fibrillation (NVAF). We hypothesized that the quantification of LASEC by ultrasound will improve its utility in predicting subsequent stroke events in patients with NVAF. Patients (n = 206) with definite NVAF receiving TEE were included for this prospective cohort study. Baseline clinical risk factors of stroke, CHADS2 score and CHA2DS2-Vasc, left atrial thrombus (LAT), the five-grades of LASEC and video intensity (VI) value of LASEC were measured. During 2 years follow-up, 20 patients (9.7%) developed stroke. VI value of LASEC in the patients with stroke was higher compared to patients without stroke (25.30 ± 3.61 vs. 8.65 ± 0.81, p < 0.001). On logistic regression analysis, LAT, qualitative LASEC, graded LASEC, VI value of LASEC and CHADS2 and CHA2DS2-Vasc score were independent predictors of stroke. Among them, the highest area under the curve of receiver operating characteristic (ROC) in predicting stroke was VI value of LASEC (p < 0.05). These results show that quantification of LASEC by VI value is the most favorable predictor of stroke in patients with NVAF, and calls for improving the utility of LASEC in predicting subsequent stroke events.
| S-EPMC4899705 | biostudies-literature
Project description: Not available
| S-EPMC11250866 | biostudies-literature