Clinical, laboratory and echocardiographic left atrial appendage thrombus predictors in patients with atrial fibrillation

Relevance. The most common and persistent arrhythmia today is atrial fibrillation (AF). Decrease in blood flow velocity in the left atrium appendage (LAA), endothelial dysfunction and hemostatic system changes can cause the development of left atrium appendage thrombosis (LAAT), which is the main source of thromboembolism in patients with AF. Numerous studies have explored various clinical, echocardiographic, and laboratory parameters as potential predictors, however, the predictive power of these parameters is still insufficient for real clinical practice. Aim of the study was to evaluate predictive ability of clinical, laboratory and echocardiographic markers in diagnosis of LAAT in patients with non-valvular AF. Materials and methods. The study included 100 patients with persistent non-valvular AF who were admitted for direct electrical cardioversion. All patients underwent clinical, laboratory, and instrumental studies, including transthoracic and transesophageal echocardiography (TEE). According to TEE results, patients were divided into 2 groups: patients with LAA thrombus «LAAT» (n = 30) and without LAA thrombus «Non LAAT» (n = 70). Statistical analysis was performed using the STATISTICA 10.0 software. Results and Discission. Patients in both groups were comparable in age, gender, prevalence of hypertension, coronary artery disease, obesity, prior stroke, and diabetes mellitus (p > 0.05). Patients with LAAT had a significantly longer duration period of persistent AF (7 [4; 9] months vs 4 [3; 6] months, p  =  0.004) in comparison with patients without LAAT. Laboratory markers of patients in both groups had no significant differences except for eGFR (p  =  0.047) and NT-proBNP level (p  =  0.011). According to the results of echocardiography, patients didn’t have differences in left atrial (LA) diameter and volume (p > 0.05). However, LA volume index was higher in patients with LAAT (p  =  0.007). When conducting a one-way ROC analysis, the NT-proBNP level of ≥ 1689 pg/ml showed the largest area under the ROC-curve (0.747) as well as the highest specificity (92.6%). Duration of persistent AF ≥ 4.5 months showed the highest sensitivity (90%). Conclusion. Patients with LAAT had longer duration of persistent AF, higher values of LA volume index, as well as higher NT-proBNP levels. Further use of these parameters could help predict LAAT development in patients with AF.