Prevalence of left atrial thrombus in patients with non-valvular atrial fibrillation: A systematic review and meta-analysis of the literature

Matteo Nicola Dario Di Minno, Pasquale Ambrosino, Antonio Dello Russo, Michela Casella, Elena Tremoli, Claudio Tondo

Research output: Contribution to journalArticle

Abstract

We performed a meta-analysis about the prevalence of left atrial thrombus (LAT) in patients with atrial fibrillation (AF) undergoing trans-esophageal echocardiography (TEE). Studies reporting on LAT presence in AF patients were systematically searched in the PubMed, Web of Science, Scopus and EMBASE databases and the pooled LAT prevalence was evaluated as weighted mean prevalence (WMP). Seventy-two studies (20,516 AF patients) showed a LAT WMP of 9.8 % (95 %CI: 7.6 %-12.5 %). LAT presence was associated with a higher age (mean difference: 2.56, 95 %CI: 1.49–3.62), and higher prevalence of female gender (OR: 1.35, 95 %CI: 1.04–1.75), hypertension (OR: 1.78, 95 %CI: 1.38–2.30), diabetes mellitus (OR: 1.86, 95 %CI: 1.33–2.59) and chronic heart failure (OR: 3.67, 95 %CI: 2.40–5.60). Overall, LAT patients exhibited a higher CHADS2-score (mean difference 0.88, 95 %CI: 0.68–1.07) and a higher risk of stroke/systemic embolism (OR: 3.53, 95 %CI: 2.24–5.56) compared with those without LAT. A meta-regression showed an inverse association between LAT prevalence and the presence of anticoagulation (Z-value: –7.3, p<0.001). Indeed, studies in which 100 % of patients received oral anticoagulation reported a 3.4 % WMP of LAT (95 %CI: 1.3 %-8.7 %), whereas studies in which 0 % of patients received anticoagulation showed a LAT WMP of 7.4 % (95 %CI: 2.3 %-21.5 %). Our data suggest that LAT is present in ≈10 % of AF patients, and is associated with a 3.5-fold increased risk of stroke/systemic embolism. Interestingly, LAT is also reported in some of patients receiving anticoagulation. The implementation of the screening of LAT in AF patients before cardioversion/ablation could be useful for the prevention of vascular events.

Original languageEnglish
Pages (from-to)663-677
Number of pages15
JournalThrombosis and Haemostasis
Volume115
Issue number3
DOIs
Publication statusPublished - 2016

Fingerprint

Atrial Fibrillation
Meta-Analysis
Thrombosis
Embolism
Stroke
Electric Countershock
PubMed
Blood Vessels
Echocardiography
Diabetes Mellitus
Heart Failure
Databases
Hypertension

Keywords

  • Atrial fibrillation
  • Left atrial thrombus
  • Transesophageal echocardiography

ASJC Scopus subject areas

  • Hematology

Cite this

@article{095ba31a79994843a7a95641ccb6b9c6,
title = "Prevalence of left atrial thrombus in patients with non-valvular atrial fibrillation: A systematic review and meta-analysis of the literature",
abstract = "We performed a meta-analysis about the prevalence of left atrial thrombus (LAT) in patients with atrial fibrillation (AF) undergoing trans-esophageal echocardiography (TEE). Studies reporting on LAT presence in AF patients were systematically searched in the PubMed, Web of Science, Scopus and EMBASE databases and the pooled LAT prevalence was evaluated as weighted mean prevalence (WMP). Seventy-two studies (20,516 AF patients) showed a LAT WMP of 9.8 {\%} (95 {\%}CI: 7.6 {\%}-12.5 {\%}). LAT presence was associated with a higher age (mean difference: 2.56, 95 {\%}CI: 1.49–3.62), and higher prevalence of female gender (OR: 1.35, 95 {\%}CI: 1.04–1.75), hypertension (OR: 1.78, 95 {\%}CI: 1.38–2.30), diabetes mellitus (OR: 1.86, 95 {\%}CI: 1.33–2.59) and chronic heart failure (OR: 3.67, 95 {\%}CI: 2.40–5.60). Overall, LAT patients exhibited a higher CHADS2-score (mean difference 0.88, 95 {\%}CI: 0.68–1.07) and a higher risk of stroke/systemic embolism (OR: 3.53, 95 {\%}CI: 2.24–5.56) compared with those without LAT. A meta-regression showed an inverse association between LAT prevalence and the presence of anticoagulation (Z-value: –7.3, p<0.001). Indeed, studies in which 100 {\%} of patients received oral anticoagulation reported a 3.4 {\%} WMP of LAT (95 {\%}CI: 1.3 {\%}-8.7 {\%}), whereas studies in which 0 {\%} of patients received anticoagulation showed a LAT WMP of 7.4 {\%} (95 {\%}CI: 2.3 {\%}-21.5 {\%}). Our data suggest that LAT is present in ≈10 {\%} of AF patients, and is associated with a 3.5-fold increased risk of stroke/systemic embolism. Interestingly, LAT is also reported in some of patients receiving anticoagulation. The implementation of the screening of LAT in AF patients before cardioversion/ablation could be useful for the prevention of vascular events.",
keywords = "Atrial fibrillation, Left atrial thrombus, Transesophageal echocardiography",
author = "{Di Minno}, {Matteo Nicola Dario} and Pasquale Ambrosino and Russo, {Antonio Dello} and Michela Casella and Elena Tremoli and Claudio Tondo",
year = "2016",
doi = "10.1160/TH15-07-0532",
language = "English",
volume = "115",
pages = "663--677",
journal = "Thrombosis and Haemostasis",
issn = "0340-6245",
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}

TY - JOUR

T1 - Prevalence of left atrial thrombus in patients with non-valvular atrial fibrillation

T2 - A systematic review and meta-analysis of the literature

AU - Di Minno, Matteo Nicola Dario

AU - Ambrosino, Pasquale

AU - Russo, Antonio Dello

AU - Casella, Michela

AU - Tremoli, Elena

AU - Tondo, Claudio

PY - 2016

Y1 - 2016

N2 - We performed a meta-analysis about the prevalence of left atrial thrombus (LAT) in patients with atrial fibrillation (AF) undergoing trans-esophageal echocardiography (TEE). Studies reporting on LAT presence in AF patients were systematically searched in the PubMed, Web of Science, Scopus and EMBASE databases and the pooled LAT prevalence was evaluated as weighted mean prevalence (WMP). Seventy-two studies (20,516 AF patients) showed a LAT WMP of 9.8 % (95 %CI: 7.6 %-12.5 %). LAT presence was associated with a higher age (mean difference: 2.56, 95 %CI: 1.49–3.62), and higher prevalence of female gender (OR: 1.35, 95 %CI: 1.04–1.75), hypertension (OR: 1.78, 95 %CI: 1.38–2.30), diabetes mellitus (OR: 1.86, 95 %CI: 1.33–2.59) and chronic heart failure (OR: 3.67, 95 %CI: 2.40–5.60). Overall, LAT patients exhibited a higher CHADS2-score (mean difference 0.88, 95 %CI: 0.68–1.07) and a higher risk of stroke/systemic embolism (OR: 3.53, 95 %CI: 2.24–5.56) compared with those without LAT. A meta-regression showed an inverse association between LAT prevalence and the presence of anticoagulation (Z-value: –7.3, p<0.001). Indeed, studies in which 100 % of patients received oral anticoagulation reported a 3.4 % WMP of LAT (95 %CI: 1.3 %-8.7 %), whereas studies in which 0 % of patients received anticoagulation showed a LAT WMP of 7.4 % (95 %CI: 2.3 %-21.5 %). Our data suggest that LAT is present in ≈10 % of AF patients, and is associated with a 3.5-fold increased risk of stroke/systemic embolism. Interestingly, LAT is also reported in some of patients receiving anticoagulation. The implementation of the screening of LAT in AF patients before cardioversion/ablation could be useful for the prevention of vascular events.

AB - We performed a meta-analysis about the prevalence of left atrial thrombus (LAT) in patients with atrial fibrillation (AF) undergoing trans-esophageal echocardiography (TEE). Studies reporting on LAT presence in AF patients were systematically searched in the PubMed, Web of Science, Scopus and EMBASE databases and the pooled LAT prevalence was evaluated as weighted mean prevalence (WMP). Seventy-two studies (20,516 AF patients) showed a LAT WMP of 9.8 % (95 %CI: 7.6 %-12.5 %). LAT presence was associated with a higher age (mean difference: 2.56, 95 %CI: 1.49–3.62), and higher prevalence of female gender (OR: 1.35, 95 %CI: 1.04–1.75), hypertension (OR: 1.78, 95 %CI: 1.38–2.30), diabetes mellitus (OR: 1.86, 95 %CI: 1.33–2.59) and chronic heart failure (OR: 3.67, 95 %CI: 2.40–5.60). Overall, LAT patients exhibited a higher CHADS2-score (mean difference 0.88, 95 %CI: 0.68–1.07) and a higher risk of stroke/systemic embolism (OR: 3.53, 95 %CI: 2.24–5.56) compared with those without LAT. A meta-regression showed an inverse association between LAT prevalence and the presence of anticoagulation (Z-value: –7.3, p<0.001). Indeed, studies in which 100 % of patients received oral anticoagulation reported a 3.4 % WMP of LAT (95 %CI: 1.3 %-8.7 %), whereas studies in which 0 % of patients received anticoagulation showed a LAT WMP of 7.4 % (95 %CI: 2.3 %-21.5 %). Our data suggest that LAT is present in ≈10 % of AF patients, and is associated with a 3.5-fold increased risk of stroke/systemic embolism. Interestingly, LAT is also reported in some of patients receiving anticoagulation. The implementation of the screening of LAT in AF patients before cardioversion/ablation could be useful for the prevention of vascular events.

KW - Atrial fibrillation

KW - Left atrial thrombus

KW - Transesophageal echocardiography

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