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Thromb Haemost 2023; 123(05): 522-534
DOI: 10.1055/a-1983-0516
Stroke, Systemic or Venous Thromboembolism

Severe Left Atrial Spontaneous Echo Contrast in Nonvalvular Atrial Fibrillation: Clinical Characteristics and Impact on Ischemic Risk Postablation

Hao Wang
1   Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
,
Siqi Xi   *
1   Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
,
Jindong Chen   *
1   Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
,
Liang Zhao
1   Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
,
Tian Gan
1   Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
,
Ben He   **
1   Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
› Author Affiliations Funding This research was funded by a grant from the National Natural Science Foundation of China (No. 81970276) and Experimental Animal Model Project of Science and Technology Commission of Shanghai Municipality (No. 19140904702).
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Abstract

Background Spontaneous echo contrast (SEC) is an important precursor for intracardiac thrombus and stroke. There are very limited data on characteristics of severe SEC and its impact on ischemic risk of nonvalvular atrial fibrillation (NVAF) patients after radiofrequency catheter ablation.

Methods Transesophageal echocardiography files were reviewed between March 2009 and March 2021 in this monocentric retrospective study. SEC was classified into four levels. The primary endpoint was thromboembolic event (stroke, myocardial infarction, systemic embolism, and ensuing death), and the secondary endpoint included nonischemic mortality and recurrent atrial arrhythmia.

Results Six hundred SEC cases were enrolled and classified into mild SEC group (Grade 1–2, n = 515) and severe SEC group (Grade 3–4, n = 85). Independent risk factors for severe SEC included higher brain natriuretic peptide (BNP), erythrocyte sedimentation rate (ESR), and LAd/∆LVED (LAd = left atrial diameter; ∆LVED = left ventricular end-diastolic diameter − left ventricular end-systolic diameter). The severe SEC group had a higher peri-procedural ischemic event occurrence (7.1 vs. 1.9%, p = 0.007). At a median follow-up of 55 months, the severe SEC group had a lower freedom rate from ischemic events (90.1 vs. 75.3%, p < 0.001); older age and severe SEC were independent risk factors for ischemic events. In patients undergoing redo-procedure (n = 100), a remarkably reduced ESR (17.8 ± 12.0 vs. 28.2 ± 19.0 mm/h, p < 0.001) was observed in patients whose SEC disappeared.

Conclusion Higher BNP, ESR, and LAd/∆LVED were the independent predictors for severe SEC. Severe SEC was associated with higher peri-procedural and long-term ischemic risks. ESR and LAd/∆LVED, as indicators of hematological and hemodynamic change, seemed helpful in identifying NVAF patients prone to developing severe SEC.

Keywords

spontaneous echo contrast - nonvalvular atrial fibrillation - ischemic event - radiofrequency catheter ablation

Ethical Approval Statement

Ethics approval and consent to participate: the authors assert that this study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study protocol was approved by the Shanghai Chest Hospital Ethics Committee, which waived the written informed consent requirement.


Consent for Publication

Not applicable.


Data Availability Statement

The data are available from the corresponding author (Prof. Liang Zhao) on reasonable request.


Authors' Contribution

Conception and design: L.Z., J.C., and H.W. Data collection: H.W., S.X., and J.C. Data analysis and interpretation: H.W. and L.Z. Manuscript writing: all authors. Final approval of manuscript: all authors. Administrative support: B.H.


* Co-first author.


** Co-correspondence.




Publication History

Received: 26 June 2022

Accepted: 27 October 2022

Accepted Manuscript online:
19 November 2022

Article published online:
27 December 2022

© 2022. Thieme. All rights reserved.

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Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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