Association between thrombus formation and structural complexity of the left atrial appendage in patients with nonvalvular atrial fibrillation

doi:10.3877/cma.j.issn.1674-0785.2021.08.009

Abstract

Abstract:

Objective

To evaluate the relationship between left atrial appendage (LAA) thrombus formation and structural complexity in patients with nonvalvular atrial fibrillation (NVAF).

Methods

Patients with NVAF hospitalized between October 2018 and March 2021 at Shougang Shuigang General Hospital were enrolled in this study. Demographic data, medical history, and echocardiography parameters were collected, and CHA₂DS₂-VASc scores were calculated. Left atrium computed tomography angiography was preformed to detect LAA thrombosis. LAA morphology was evaluated by computer-assisted LAA three-dimensional reconstruction. The patients were divided into a simple type group and a complex type group according to the results of LAA morphologies. Multivariate Logistic regression analysis was performed to investigate the relationship between the structural complexity of the LAA and thrombosis.

Results

A total of 218 patients with NVAF were included in the study, of whom 104 had a simple type LAA, and 114 had a complex type. CHA₂DS₂-VASc scores [(2.4±1.70) vs (2.9±1.5), P＜0.01], the rate of stoke/transient ischemic attack (12.5% vs 27.2%, P＜0.01), the incidence of hypertension (44.2% vs 59.6%, P＜0.05), and LAA thrombosis rate (5.8% vs 16.7%, P＜0.05) were all significantly lower in the simple type group than those in the complex type group. Multivariate logistic regression analysis showed that the risk of LAA thrombosis was 3.506-fold higher in patients with complex type LAA than in those with simple type LAA [odds ratio (OR)=3.506, 95% confidence interval (CI): 1.125-10.928]. Besides, congestive heart failure (OR=12.552, 95% CI: 3.225-48.852), anteroposterior diameter of the left atrium (OR=1.082, 95% CI: 1.003-1.169), NYHA heart function grade (OR=2.103, 95% CI: 1.222-3.622), and CHA₂DS₂-VASc score (OR=1.871, 95% CI: 1.261-2.778) were independent risk factors for LAA thrombosis (P＜0.05).

Conclusion

Complex LAA significantly increases the risk of LAA thrombosis in NVAF patients.

Key words: Nonvalvular atrial fibrillation, Left atrial appendage morphology, Left atrial appendage thrombosis

Min Zhang, Meiling Xie, Wei Liu, Mingli Lv, Ximin Yin, Qunqun Yu, Guangping Chen, Lala Li, Anlei Hu, Dongying Zhao, Lian Zeng, Na Zhou, Minyan Shao, Shouli Zhao. Association between thrombus formation and structural complexity of the left atrial appendage in patients with nonvalvular atrial fibrillation[J]. Chinese Journal of Clinicians(Electronic Edition), 2021, 15(08): 605-609.

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URL: https://zhlcyszz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0785.2021.08.009

https://zhlcyszz.cma-cmc.com.cn/EN/Y2021/V15/I08/605

Figures/Tables 2

项目	单纯型左心耳组（104例）	复杂型左心耳组（114例）	统计值	P值
年龄（岁， $x ¯$ ±s）	65.2±10.3	67.8±10.9	t=-1.800	0.073
AF病程（月， $x ¯$ ±s）	23.7±32.9	31.5±64.7	t=-1.133	0.259
LAD（mm， $x ¯$ ±s）	39.7±8.8	38.6±6.4	t=1.087	0.279
LVEDD（mm， $x ¯$ ±s）	47.6±8.6	45.9±8.9	t=1.385	0.168
LVEF（%， $x ¯$ ±s）	56.0±8.7	56.7±9.6	t=-0.514	0.606
CHA₂DS₂-VASc评分（分， $x ¯$ ±s）	2.4±1.7	2.9±1.5	t=-2.660	0.008
男性［例（%）］	44（42.3）	52（45.6）	χ²=0.241	0.623
持续性AF［例（%）］	60（57.7）	79（61.4）	χ²=0.311	0.577
充血性心力衰竭［例（%）］	44（42.3）	50（43.9）	χ²=0.053	0.817
高血压［例（%）］	46（44.2）	68（59.6）	χ²=5.182	0.023
糖尿病［例（%）］	10（9.6）	20（17.5）	χ²=2.881	0.090
脑卒中/TIA/TE［例（%）］	13（12.5）	31（27.2）	χ²=7.288	0.007
LAA血栓［例（%）］	6（5.8）	19（16.7）	χ²=6.361	0.012
NYHA心功能分级［例（%）］			χ²=0.468	0.926
Ⅰ级	54（51.9）	62（54.4）
Ⅱ级	24（23.1）	22（19.3）
Ⅲ级	12（11.5）	14（12.3）
Ⅳ级	14（13.5）	16（14.0）

项目	单纯型左心耳组（104例）	复杂型左心耳组（114例）	统计值	P值
年龄（岁， $x ¯$ ±s）	65.2±10.3	67.8±10.9	t=-1.800	0.073
AF病程（月， $x ¯$ ±s）	23.7±32.9	31.5±64.7	t=-1.133	0.259
LAD（mm， $x ¯$ ±s）	39.7±8.8	38.6±6.4	t=1.087	0.279
LVEDD（mm， $x ¯$ ±s）	47.6±8.6	45.9±8.9	t=1.385	0.168
LVEF（%， $x ¯$ ±s）	56.0±8.7	56.7±9.6	t=-0.514	0.606
CHA₂DS₂-VASc评分（分， $x ¯$ ±s）	2.4±1.7	2.9±1.5	t=-2.660	0.008
男性［例（%）］	44（42.3）	52（45.6）	χ²=0.241	0.623
持续性AF［例（%）］	60（57.7）	79（61.4）	χ²=0.311	0.577
充血性心力衰竭［例（%）］	44（42.3）	50（43.9）	χ²=0.053	0.817
高血压［例（%）］	46（44.2）	68（59.6）	χ²=5.182	0.023
糖尿病［例（%）］	10（9.6）	20（17.5）	χ²=2.881	0.090
脑卒中/TIA/TE［例（%）］	13（12.5）	31（27.2）	χ²=7.288	0.007
LAA血栓［例（%）］	6（5.8）	19（16.7）	χ²=6.361	0.012
NYHA心功能分级［例（%）］			χ²=0.468	0.926
Ⅰ级	54（51.9）	62（54.4）
Ⅱ级	24（23.1）	22（19.3）
Ⅲ级	12（11.5）	14（12.3）
Ⅳ级	14（13.5）	16（14.0）

变量	B	SE	Wald	P值	OR值	95% CI
变量	B	SE	Wald	P值	OR值	下限	上限
女性	1.488	0.582	6.531	0.011	4.430	1.415	13.872
充血性心力衰竭	2.530	0.693	13.315	0.000	12.552	3.225	48.852
复杂型左心耳	1.255	0.580	4.680	0.031	3.506	1.125	10.928
LAD	0.079	0.039	4.111	0.043	1.082	1.003	1.169
NYHA心功能分级	0.744	0.277	7.191	0.007	2.103	1.222	3.622
CHA₂DS₂-VASc评分	0.627	0.202	9.664	0.002	1.871	1.261	2.778
常量	-11.820	2.423	23.793	0.000	0.000

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