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- Title
Risk factors for thrombosis and spontaneous echocardiographic contrast with sludge in atrial fibrillation patients treated with oral anticoagulants before electrical cardioversion.
- Authors
Rekosz, Jerzy; Karwowski, Jarosław; Kowalik, Ilona; Wiktorska, Anna; Wrzosek, Karol; Solecki, Mateusz; Szmarowska, Katarzyna; Szymańska, Anna; Mierzejewska, Beata; Syska-Sumińska, Joanna; Dłużniewski, Mirosław
- 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.
- Subjects
THROMBOSIS risk factors; ATRIAL fibrillation treatment; ANTICOAGULANTS; TRANSESOPHAGEAL echocardiography; ELECTRIC countershock; RISK assessment; VENTRICULAR ejection fraction; T-test (Statistics); SEX distribution; FISHER exact test; LOGISTIC regression analysis; RETROSPECTIVE studies; DESCRIPTIVE statistics; MULTIVARIATE analysis; CHI-squared test; MANN Whitney U Test; HEMODYNAMICS; BENZIMIDAZOLES; ODDS ratio; ATRIAL fibrillation; PYRIDINE; STATISTICS; MEDICAL records; ACQUISITION of data; BLOOD flow measurement; CONFIDENCE intervals; DATA analysis software; COMPARATIVE studies; RIVAROXABAN; ECHOCARDIOGRAPHY; NONPARAMETRIC statistics
- Publication
Polish Heart Journal / Kardiologia Polska, 2024, Vol 82, Issue 5, p516
- ISSN
0022-9032
- Publication type
Article
- DOI
10.33963/v.phj.100078