Heart failure as an independent predictor of thrombus persistence in nonvalvular atrial fibrillation: a transesophageal echocardiography‑based study

INTRODUCTION Formation of left atrial (LA) thrombus is one of the most serious complications in patients with atrial fibrillation (AF).

OBJECTIVES The aim of our study was to determine the predictors of LA thrombus resolution among patients with AF receiving oral anticoagulation. 

PATIENTS AND METHODS After a retrospective analysis of 1877 transesophageal echocardiographic examinations (TEEs) performed in our department between January 2009 and June 2013, we included 64 patients (women, 36%; mean age at diagnosis, 64 ±8.8 years) with nonvalvular AF and LA thrombi on TEE into the study. All patients received oral anticoagulation and underwent follow‑up TEE within a few months since diagnosis.

RESULTS After a mean follow‑up period of 88 ±107 days, thrombus resolution was observed in 30 patients (47%). The univariate Cox proportional regression model showed that heart failure and reduced left ventricular ejection fraction were associated with the persistence of LA thrombus (hazard ratio [HR], 2.72; 95% confidence interval [CI], 1.32–5.61; P = 0.007 and HR, 0.97; 95% CI, 0.94–0.99; P = 0.04; respectively). The international normalized ratio and CHA2DS2‑VASc score were not prognostic for thrombus resolution (HR, 0.64; 95% CI, 0.37–1.1; P = 0.1 and HR 1.10; 95% CI, 0.91–1.33; P = 0.3; respectively). In a multivariate analysis, heart failure was the only independent factor predicting unsuccessful resolution of LA thrombus (P = 0.04).

CONCLUSIONS Heart failure is an independent negative predictor of LA thrombus resolution in patients with AF receiving oral anticoagulation.