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European Journal of Echocardiography Advance Access originally published online on October 2, 2008
European Journal of Echocardiography 2009 10(3):383-388; doi:10.1093/ejechocard/jen256
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org.

Prevalence and clinical impact of left atrial thrombus and dense spontaneous echo contrast in patients with atrial fibrillation and low CHADS2 score

Thomas Kleemann1,*, Torsten Becker1, Margit Strauss1, Steffen Schneider2 and Karlheinz Seidl1

1 Herzzentrum Ludwigshafen, Klinikum Ludwigshafen, Medizinische Klinik B, Bremserstraße 79, D-67063 Ludwigshafen, Germany
2 Institut für Herzinfarktforschung an der Universität Heidelberg, Heidelberg, Germany

Received 27 January 2008; accepted after revision 12 September 2008; online publish-ahead-of-print 2 October 2008.

* Corresponding author. Tel: +49 621 503 4025; fax: +49 621 503 4028. E-mail address: kleemann.thomas{at}web.de


  Abstract

Aims: To evaluate the prevalence and clinical impact of left atrial (LA) thrombus and dense spontaneous echo contrast (SEC) in patients with atrial fibrillation (AF) and low CHADS2 score undergoing cardioversion.

Methods and results: A total of 295 consecutive patients with non-valvular AF and a CHADS2 score of 0 or 1 from the prospective single-centre registry ANTIK, who underwent transoesophageal echocardiography before cardioversion, were included in the study. Median follow-up was 5 years. LA thrombus was present in 3% and dense SEC in 8% of patients. Independent predictors for the presence of thrombus or dense SEC were ejection fraction (EF) <40% and LA diameter ≥50 mm. In anticoagulated patients, thrombus and dense SEC were not independently associated with an increased risk for stroke or death during the 5 year follow-up (OR 1.55, 95% CI 0.50–4.83).

Conclusions: Despite a low CHADS2 score of 0/1, 3% of patients have LA thrombus and 8% of patients have dense SEC. Independent predictors for the presence of thrombus and dense SEC were EF <40% and LA dimension ≥50 mm. Thus, echocardiography might be a useful tool for further risk stratification in patients with low CHADS2 score.

Keywords: Atrial fibrillation; CHADS2; Transoesophageal echocardiography; Thrombus; Spontaneous echo contrast


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