Journal of Shanghai Jiao Tong University (Medical Science) >

2022 , Vol. 42 >Issue 3: 344 - 349

DOI: https://doi.org/10.3969/j.issn.1674-8115.2022.03.012

Clinical research

Clinical analysis of left atrial spontaneous echo contrast before and after left atrial appendage closure in patients with atrial fibrillation

  • Zhihong ZHAO ,
  • Saihua WANG ,
  • Shuwen HAO ,
  • Xiang SONG ,
  • Jun LUO ,
  • Yingbiao WU ,
  • Qian ZHU ,
  • Ming FANG ,
  • Bei TIAN ,
  • Wei GU ,
  • Zhongping NING
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  • Department of Cardiology, Shanghai Pudong New Area Zhoupu Hospital, Shanghai University of Medicine & Health Sciences, Shanghai 201318, China
NING Zhongping, E-mail: ningzhongping88@163.com.

Received date: 2021-09-03

  Online published: 2022-05-09

Supported by

Shanghai Pudong Top Level Clinical Discipline Fund(PWYgf2021-04);Shanghai Key Medical Specialty Program Construction Fund(ZK2019B25);Shanghai Pudong Science and Technology Development Fund(PKJ2021-y33);Shanghai Pudong Health Committee Key Sub-Specialized Construction Fund(PWZy2020-08)

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Abstract

Objective

·To investigate the occurrence of left atrial spontaneous echo contrast (LA SEC) both before and after left atrial appendage closure (LAAC) in the atrial fibrillation (AF) patients, and its relationship with device-related thrombus (DRT) and clinical prognosis.

Methods

·This study was a retrospective, cross-sectional study. A total of 126 nonvalvular AF patients receiving LAAC with LAmbre and completing transesophageal echocardiography (TEE) review were enrolled from August 2018 to December 2020 in Shanghai Pudong New Area Zhoupu Hospital, Shanghai University of Medicine & Health Sciences. The proportion of AF patients with LA SEC was 19.8% (25/126) before LAAC. The AF patients were divided into LA SEC group (n=25) and non-LA SEC group (n=101), and the clinical data, LAAC-related data, and perioperative complications were analyzed. TEE review time median was 72 d after LAAC. The patients were redivided into LA SEC group (n=58) and non-LA SEC group (n=68) for analysis. The average follow-up was (12±6) months. The incidence of DRT was compared, and the incidences of ischemic stroke and cerebral hemorrhage events were followed up.

Results

·Before LAAC, the proportion of oral anticoagulation was low, the left atrium diameter and the left ventricle diameter increased, and the left ventricle ejection fraction decreased in the LA SEC group. The incidence of LA SEC after LAAC reviewed by TEE increased to 46.0%, including 38.1% (48/126) new occurred LA SEC patients, and 40.0% (10/25) LA SEC patients with LA SEC. The redivided LA SEC group had longer left atrial appendage orifice diameter and lower application rate of anticoagulant treatment regimen. There was no significant difference in the incidence of death, ischemic stroke/transient ischemic attack, and cerebral hemorrhage between the two groups (all P>0.05).

Conclusion

·The AF patients undergoing LAAC with LA SEC before operation are characterized by low anticoagulation ratio, left atrium and left ventricle enlargement, and decreased left ventricle ejection fraction. After LAAC with LAmbre, the LA SEC patients diagnosed by TEE review have longer left atrial appendage ostium diameter and lower anticoagulant treatment regimen ratio. LA SEC does not affect the clinical prognosis.

Key words： atrial fibrillation; left atrial appendage closure (LAAC); left atrial spontaneous echo contrast (LA SEC); device-related thrombus (DRT)

Cite this article

Zhihong ZHAO , Saihua WANG , Shuwen HAO , Xiang SONG , Jun LUO , Yingbiao WU , Qian ZHU , Ming FANG , Bei TIAN , Wei GU , Zhongping NING . Clinical analysis of left atrial spontaneous echo contrast before and after left atrial appendage closure in patients with atrial fibrillation[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022 , 42(3) : 344 -349 . DOI: 10.3969/j.issn.1674-8115.2022.03.012

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