Risk factors for left atrial thrombus in younger patients (aged < 65 years) with atrial fibrillation or atrial flutter: Data from the multicenter left atrial thrombus on transesophageal echocardiography (LATTEE) registry

Beata Uziȩbło-Życzkowska; Agnieszka Kapłon-Cieślicka; Monika Gawałko; Monika Budnik; Katarzyna Starzyk; Beata Wożakowska-Kapłon; Ludmiła Daniłowicz-Szymanowicz; Damian Kaufmann; Maciej Wójcik; Robert Błaszczyk; Jarosław Hiczkiewicz; Katarzyna Łojewska; Katarzyna Mizia-Stec; Maciej Wybraniec; Katarzyna Kosmalska; Marcin Fijałkowski; Anna Szymańska; Aleksandra Gos; Maciej Haberka; Michał Kucio; Błazej Michalski; Karolina Kupczyńska; Anna Tomaszuk-Kazberuk; Katarzyna Wilk-Śledziewska; Renata Wachnicka-Truty; Marek Koziński; Paweł Burchardt; Paweł Krzesiński

doi:10.3389/fcvm.2022.973043

Risk factors for left atrial thrombus in younger patients (aged < 65 years) with atrial fibrillation or atrial flutter: Data from the multicenter left atrial thrombus on transesophageal echocardiography (LATTEE) registry

Front Cardiovasc Med. 2022 Oct 12:9:973043. doi: 10.3389/fcvm.2022.973043. eCollection 2022.

Authors

Beata Uziȩbło-Życzkowska¹, Agnieszka Kapłon-Cieślicka^{2

3}, Monika Gawałko^{2

3

4

5}, Monika Budnik^{2

3}, Katarzyna Starzyk⁶, Beata Wożakowska-Kapłon⁶, Ludmiła Daniłowicz-Szymanowicz⁷, Damian Kaufmann⁷, Maciej Wójcik^{2

8}, Robert Błaszczyk⁸, Jarosław Hiczkiewicz^{9

10}, Katarzyna Łojewska¹⁰, Katarzyna Mizia-Stec^{2

11

12}, Maciej Wybraniec^{2

11

12}, Katarzyna Kosmalska¹³, Marcin Fijałkowski¹⁴, Anna Szymańska¹⁵, Aleksandra Gos¹⁵, Maciej Haberka^{2

16}, Michał Kucio¹⁶, Błazej Michalski^{2

17}, Karolina Kupczyńska^{2

17}, Anna Tomaszuk-Kazberuk¹⁸, Katarzyna Wilk-Śledziewska¹⁸, Renata Wachnicka-Truty¹⁹, Marek Koziński^{2

19}, Paweł Burchardt^{2

20}, Paweł Krzesiński^{1

2}

Affiliations

¹ Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland.
² "Club 30", Polish Cardiac Society, Katowice, Poland.
³ 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
⁴ West German Heart and Vascular Centre, Institute of Pharmacology, University Duisburg-Essen, Duisburg, Germany.
⁵ Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, Netherlands.
⁶ Collegium Medicum, Jan Kochanowski University, Kielce, Poland.
⁷ Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland.
⁸ Department of Cardiology, Medical University of Lublin, Lublin, Poland.
⁹ Collegium Medicum, University of Zielona Góra, Zielona Góra, Poland.
¹⁰ Clinical Department of Cardiology, Nowa Sól Multidisciplinary Hospital, Nowa Sol, Poland.
¹¹ Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
¹² Members of the European Reference Network on Heart Diseases-ERN GUARD-HEART, Amsterdam, Netherlands.
¹³ Department of Cardiology, St. Vincent Hospital, Gdynia, Poland.
¹⁴ 1st Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland.
¹⁵ Department of Heart Diseases, Postgraduate Medical School, Warsaw, Poland.
¹⁶ Department of Cardiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland.
¹⁷ Department of Cardiology, Medical University of Lodz, Lodz, Poland.
¹⁸ Department of Cardiology, Medical University of Bialystok, Bialystok, Poland.
¹⁹ Department of Cardiology and Internal Medicine, Medical University of Gdańsk, Gdynia, Poland.
²⁰ Department of Hypertension, Angiology, and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland.

Abstract

Background: Our aim was to assess the characteristics and to identify predictors of left atrial thrombus (LAT) in patients under age 65 with atrial fibrillation (AF) or atrial flutter (AFl).

Methods: We conducted a subanalysis of a multicenter, prospective, observational study [the LATTEE registry]. Consecutive AF/AFl patients referred for cardioversion or ablation were enrolled.

Results: Of the 3,109 patients included in the study, 1,276 were under age 65 (41%). Compared to non-LAT patients, those with LAT (n = 76) had higher CHA₂DS₂-VASc score (p < 0.001), more frequently had non-paroxysmal AF/AFl (p < 0.001), heart failure (p < 0.001), history of diabetes mellitus (p = 0.001), transient ischemic attack (p = 0.04), coronary artery disease (p = 0.02), and chronic kidney disease (p < 0.001). The LAT patients were also more often smokers (p = 0.004) and were more frequently treated with vitamin K antagonists (VKAs) (p < 0.001). Transthoracic echocardiography revealed a higher left atrial area (p < 0.001), lower left ventricular ejection fraction (LVEF) (p < 0.001), and lower value of LA appendage emptying volume in LAT than in non-LAT patients (p < 0.001). LVEF (OR 2.95; 95% CI: 1.32-6.59, p = 0.008), non-paroxysmal AF/AFl (OR 7.1; 95% CI: 2.05-24.63, p = 0.002) and treatment with VKAs (OR 4.92; 95% CI: 2.48-9.75, p < 0.001) were identified as independent predictors of LAT in younger patients.

Conclusions: Our study, which focused on younger patients with AF/AFl, indicated substantial clinical and echocardiographic differences between participants with and without LAT. In the AF/AFl patients younger than age 65, the independent predictors of LAT included non-paroxysmal AF/AFl, lower LVEF, and treatment with VKAs.

Keywords: atrial fibrillation; left atrial thrombus; thromboembolic risk factors; transesophageal echocardiography; young age group.

Copyright © 2022 Uziȩbło-Życzkowska, Kapłon-Cieślicka, Gawałko, Budnik, Starzyk, Wożakowska-Kapłon, Daniłowicz-Szymanowicz, Kaufmann, Wójcik, Błaszczyk, Hiczkiewicz, Łojewska, Mizia-Stec, Wybraniec, Kosmalska, Fijałkowski, Szymańska, Gos, Haberka, Kucio, Michalski, Kupczyńska, Tomaszuk-Kazberuk, Wilk-Śledziewska, Wachnicka-Truty, Koziński, Burchardt and Krzesiński.