J Stroke.  2023 Jan;25(1):111-118. 10.5853/jos.2022.02068.

Impact of Left Atrial or Left Atrial Appendage Thrombus on Stroke Outcome: A Matched Control Analysis

• Heo J
• Lee H
• Lee IH
• Nam HS
• Kim YD

• KMID: 2539063
• DOI: http://doi.org/10.5853/jos.2022.02068

Abstract

Background and Purpose
Left atrial or left atrial appendage (LA/LAA) thrombi are frequently observed during cardioembolic evaluation in patients with ischemic stroke. This study aimed to investigate stroke outcomes in patients with LA/LAA thrombus.
Methods
This retrospective study included patients admitted to a single tertiary center in Korea between January 2012 and December 2020. Patients with nonvalvular atrial fibrillation who underwent transesophageal echocardiography or multi-detector coronary computed tomography were included in the study. Poor outcome was defined as modified Rankin Scale score >3 at 90 days. The inverse probability of treatment weighting analysis was performed.
Results
Of the 631 patients included in this study, 68 (10.7%) had LA/LAA thrombi. Patients were likely to have a poor outcome when an LA/LAA thrombus was detected (42.6% vs. 17.4%, P<0.001). Inverse probability of treatment weighting analysis yielded a higher probability of poor outcomes in patients with LA/LAA thrombus than in those without LA/LAA thrombus (P<0.001). Patients with LA/LAA thrombus were more likely to have relevant arterial occlusion on angiography (36.3% vs. 22.4%, P=0.047) and a longer hospital stay (8 vs. 7 days, P<0.001) than those without LA/LAA thrombus. However, there was no difference in early neurological deterioration during hospitalization or major adverse cardiovascular events within 3 months between the two groups.
Conclusions
Patients with ischemic stroke who had an LA/LAA thrombus were at risk of a worse functional outcome after 3 months, which was associated with relevant arterial occlusion and prolonged hospital stay.

Keyword

Atrial fibrillation; Ischemic stroke; Heart atria; Atrial appendage; Thrombosis; Prognosis

Figure

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  Figure 1. Flow chart of the included patients. TEE, transesophageal echocardiography; MDCT, multi-detector coronary computed tomography; mRS, modified Rankin Scale.

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  Figure 2. Distribution of the 3-month mRS score between patients with LA/LAA and those without LA/LAA for (A) the original dataset and (B) the inverse probability of treatment weighted dataset. Values represent number of patients (percentage). LA/LAA, left atrial or appendage; mRS, modified Rankin Scale.

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  Figure 3. Standardized mean differences of variables used for weighting to compare the balance between the two groups. Thrombolysis is defined as a composite of intravenous alteplase infusion and endovascular thrombectomy. A high E/e’ ratio was defined as a ratio >15. Poor pre-stroke mRS scores were defined as scores of >3. Old age was defined as >75 years. Low EF was defined as a value <40%. Low GFR was defined as a value of <30 mL/min/1.73 m2. A high initial NIHSS score was defined as a score >10. E/e’, early mitral inflow velocity to mitral annular early diastolic velocity ratio; mRS, modified Rankin Scale; EF, ejection fraction; GFR, glomerular filtration rate; NIHSS, National Institutes of Health Stroke Scale; CHF, congestive heart failure; CAOD, coronary artery occlusive disease.

Reference

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