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Risk factors for thrombosis and spontaneous echocardiographic contrast with sludge in atrial fibrillation patients treated with oral anticoagulants before electrical cardioversion.
Rekosz, Jerzy; Karwowski, Jaroslaw; Kowalik, Ilona; Wiktorska, Anna; Wrzosek, Karol; Solecki, Mateusz; Szmarowska, Katarzyna; Szymanska, Anna; Mierzejewska, Beata; Syska-Suminska, Joanna; Dluzniewski, Miroslaw.
Affiliation
  • Rekosz J; 2nd Department of Cardiology, Masovian Brodnowski Hospital, Warszawa, Poland. jerzy.rekosz@op.pl.
  • Karwowski J; Department of Heart Diseases, Postgraduate Medical School, Warszawa, Poland.
  • Kowalik I; National Institute of Cardiology. Clinical Research Support Center, Warszawa, Poland.
  • Wiktorska A; 2nd Department of Cardiology, Masovian Brodnowski Hospital, Warszawa, Poland.
  • Wrzosek K; Department of Heart Diseases, Postgraduate Medical School, Warszawa, Poland.
  • Solecki M; 2nd Department of Cardiology, Masovian Brodnowski Hospital, Warszawa, Poland.
  • Szmarowska K; 2nd Department of Cardiology, Masovian Brodnowski Hospital, Warszawa, Poland.
  • Szymanska A; 2nd Department of Cardiology, Masovian Brodnowski Hospital, Warszawa, Poland.
  • Mierzejewska B; 2nd Department of Cardiology, Masovian Brodnowski Hospital, Warszawa, Poland.
  • Syska-Suminska J; Department of Heart Diseases, Postgraduate Medical School, Warszawa, Poland.
  • Dluzniewski M; Department of Heart Diseases, Postgraduate Medical School, Warszawa, Poland.
Kardiol Pol ; 82(5): 516-526, 2024.
Article in En | MEDLINE | ID: mdl-38606742
ABSTRACT

BACKGROUND:

Knowledge of thrombosis (T) risk predictors and transesophageal echocardiography (TEE) are important tools in appropriate qualification of patients for safe electrical cardioversion.

AIMS:

We aimed to investigate predictors of T and spontaneous echocardiographic contrast (SEC) with sludge in the left atrium (LA) and appendage (LAA) in atrial fibrillation (AF) patients on oral anticoagulation.

METHODS:

The study included 300 patients with AF lasting >48 hours. Two hundred and nineteen patients were treated with oral anticoagulants (OACs) (study group, rivaroxaban 104 [47.5%], apixaban 52 [23.7%], dabigatran 23 [11.5%], VKAs 40 [18.3%]). Eighty-one consecutive patients with AF lasting >48 hours and not treated with OACs constituted the control group. Before electrical cardioversion, all patients underwent transthoracic echocardiography and TEE.

RESULTS:

TEE revealed T in the LAA in 4.7% of cases. The number of patients with T or SEC4+ with sludge in the OAC and control groups was similar, 5.9% vs. 1.2% and 16.4% vs. 16.0%, respectively. The risk of SEC4+/T in patients treated with OACs was lowest in those taking rivaroxaban (odds ratio [OR], 0.42; 95% confidence interval [CI], 0.21-0.87; P = 0.027) and highest in those receiving VKAs (OR, 2.49; 95% CI, 1.15-5.39; P = 0.018). Multivariable analysis showed independent prognostic factors for SEC 4+/T female sex (OR, 3.800; 95% CI, 1.592-9.072; P = 0.003), left ventricular ejection fraction (OR, 0.932; 95% CI, 0.890-0.957; P <0.001), and minimum LAA flow velocity (LAAfly min) (OR, 0.895; 95% CI, 0.841-0.954; P <0.001).

CONCLUSIONS:

Female sex, transthoracic echocardiography, and TEE results should be taken into account in assessing the risk of T/SEC with sludge in LA/LAA patients with AF.
Subject(s)
Key words

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Atrial Fibrillation / Thrombosis / Electric Countershock / Echocardiography, Transesophageal / Anticoagulants Limits: Aged / Female / Humans / Male / Middle aged Language: En Journal: Kardiol Pol Year: 2024 Document type: Article Affiliation country: Poland

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Atrial Fibrillation / Thrombosis / Electric Countershock / Echocardiography, Transesophageal / Anticoagulants Limits: Aged / Female / Humans / Male / Middle aged Language: En Journal: Kardiol Pol Year: 2024 Document type: Article Affiliation country: Poland