Dissertation
Dissertation > Medicine, health > Internal Medicine > Heart, blood vessels ( circulatory ) disease > Heart disease > Arrhythmia > Atrial fibrillation and atrial flutter

Predictors of Left Atrial Thrombus in Patients with Non-valvular Atrial Fibrillation

Author ZhangXianRui
Tutor SuLi
School Chongqing Medical University
Course Internal Medicine
Keywords atrial fibrillation left atrial thrombus transesophagealechocardiography CHADS2score CHA2DS2-VASc score
CLC R541.75
Type Master's thesis
Year 2013
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Aims: To evaluate the predictive value of some clinical parameters,CHADS2score and CHA2DS2-VASc score in the incidence of left atrialthrombus (LAT) in patients with non-valvular atrial fibrillation(AF).Methods: Two hundred and three non-valvular AF patients wereincluded in this retrospective cohort study. All patients underwenttransesophageal echocardiography (TEE) to detect left atrial thrombus(LAT).(Other clinical data were also collected, including demographic parameters,cardiovascular risk factors, antithrombotic medications, lipid profiles andLeft Atrial Volume index (LAVI)). The CHADS2scores, CHA2DS2-VAScscore and CHA2DS2-VASc-LA2were calculated in all patients. The methodsof univariate analysis and multivariate logistic regression analysis wereemployed to identify the predictors of LAT. The diagnosis value of the abovementioned three systems of risk scores were analyzed using receiveroperating characteristic (ROC) curve.Results: Of the203patients,39with and164without LAT wereidentified by TEE. In the univariate analysis, non-paroxysmal AF, pulmonary hypertension(PH), CHADS2score,CHA2DS2-VASc score, HDLlevel, left atrial diameter(LAD) and LAVI were predictors of LAT.Multivariate logistic regression analysis demonstrated that CHA2DS2-VAScscore≥2(OR=4.462,95%CI1.707-11.668, p=0.002),LAVI≥32ml/m2(OR=4.271,95%CI1.915-9.528, P<0.001) wereindependent predictors of LAT. Based on that, we recorded LAVI≥32ml/m2as2points and made CHA2DS2-VASCscore into CHA2DS2-VASc-LA2sorceand obtained the result of [4.90±2.20vs2.72±2.10P<0.001]. Receiveroperating characteristic (ROC) curve were analyzed in CHADS2score [AUC(under the cure)=0.661, p=0.002], CHA2DS2-VASCscore [AUC=0.731,P<0.001] and CHA2DS2-VASc-LA2score [AUC=0.771, P<0.001].Conclusion: The predicted value of left atrial thrombosis withCHADS2was humble in this study population. CHA2DS2-VASc scores andLAVI were the independent risk factors for LAT. Compared with thecurrently proposed two score systems, CHA2DS2-VASc-LA2score might bepreferred to predict left atrial thrombosis in low-risk stratification patientswith nonvalvular AF. None of the three score systems can absolutelysupersede the TEE detection LAT in preparing catheter ablation of AF.

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