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Abstract：
OBJECTIVE: Blood stasis is crucial in developing left atrial (LA) thrombi. LA appendage peak flow velocity (LAAFV) is a quantitative parameter for estimating thromboembolic risk. However, its impact on LA thrombus resolution and clinical outcomes remains unclear.
RESULTS: The LAT study was a multicentre observational study investigating patients with atrial fibrillation (AF) and silent LA thrombi detected by transoesophageal echocardiography (TEE). Among 17 436 TEE procedures for patients with AF, 297 patients (1.7%) had silent LA thrombi. Excluding patients without follow-up examinations, we enrolled 169 whose baseline LAAFV was available. Oral anticoagulation use increased from 85.7% at baseline to 97.0% at the final follow-up (P < 0.001). During 1 year, LA thrombus resolution was confirmed in 130 (76.9%) patients within 76 (34-138) days. Conversely, 26 had residual LA thrombi, 8 had thromboembolisms, and 5 required surgical removal. These patients with failed thrombus resolution had lower baseline LAAFV than those with successful resolution (18.0 [15.8-22.0] vs. 22.2 [17.0-35.0], P = 0.003). Despite limited predictive power (area under the curve, 0.659; P = 0.001), LAAFV ≤ 20.0 cm/s (best cut-off) significantly predicted failed LA thrombus resolution, even after adjusting for potential confounders (odds ratio, 2.72; 95% confidence interval, 1.22-6.09; P = 0.015). The incidence of adverse outcomes including ischaemic stroke/systemic embolism, major bleeding, or all-cause death was significantly higher in patients with reduced LAAFV than in those with preserved LAAFV (28.4% vs. 11.6%, log-rank P = 0.005).
CONCLUSIONS: Failed LA thrombus resolution was not rare in patients with AF and silent LA thrombi. Reduced LAAFV was associated with failed LA thrombus resolution and adverse clinical outcomes.
RESULTS: The LAT study was a multicentre observational study investigating patients with atrial fibrillation (AF) and silent LA thrombi detected by transoesophageal echocardiography (TEE). Among 17 436 TEE procedures for patients with AF, 297 patients (1.7%) had silent LA thrombi. Excluding patients without follow-up examinations, we enrolled 169 whose baseline LAAFV was available. Oral anticoagulation use increased from 85.7% at baseline to 97.0% at the final follow-up (P < 0.001). During 1 year, LA thrombus resolution was confirmed in 130 (76.9%) patients within 76 (34-138) days. Conversely, 26 had residual LA thrombi, 8 had thromboembolisms, and 5 required surgical removal. These patients with failed thrombus resolution had lower baseline LAAFV than those with successful resolution (18.0 [15.8-22.0] vs. 22.2 [17.0-35.0], P = 0.003). Despite limited predictive power (area under the curve, 0.659; P = 0.001), LAAFV ≤ 20.0 cm/s (best cut-off) significantly predicted failed LA thrombus resolution, even after adjusting for potential confounders (odds ratio, 2.72; 95% confidence interval, 1.22-6.09; P = 0.015). The incidence of adverse outcomes including ischaemic stroke/systemic embolism, major bleeding, or all-cause death was significantly higher in patients with reduced LAAFV than in those with preserved LAAFV (28.4% vs. 11.6%, log-rank P = 0.005).
CONCLUSIONS: Failed LA thrombus resolution was not rare in patients with AF and silent LA thrombi. Reduced LAAFV was associated with failed LA thrombus resolution and adverse clinical outcomes.
摘要：
目的：血瘀在左心房（LA）血栓形成中至关重要。左心耳峰值流速(LAAFV)是用于估计血栓栓塞风险的定量参数。然而,其对LA血栓消退和临床结局的影响尚不清楚.
结果：LAT研究是一项多中心观察性研究，调查经食管超声心动图（TEE）检测到的房颤（AF）和无症状LA血栓患者。在17,436例房颤患者的TEE手术中，297例患者（1.7％）患有无症状LA血栓。不包括没有随访检查的患者，我们纳入了169名基线LAAFV可用的患者.口服抗凝药物的使用从基线时的85.7%增加到最终随访时的97.0%(p<0.001)。在1年内,在76天（34-138天）内，在130例（76.9％）患者中确认了LA血栓消退。相反，26有残余的LA血栓，8人有血栓栓塞,5需要手术切除。这些血栓消退失败的患者的基线LAAFV低于成功消退的患者（18.0[15.8-22.0]vs.22.2[17.0-35.0]，p=0.003)。尽管预测能力有限(曲线下面积，0.659；p=0.001），LAAFV≤20.0cm/s(最佳截止值)显著预测LA血栓消退失败,即使在调整了潜在的混杂因素(赔率比，2.72；95%置信区间，1.22-6.09；p=0.015）。不良结局的发生率，包括缺血性卒中/全身性栓塞，大出血,LAAFV降低的患者或全因死亡显着高于LAAFV保留的患者（28.4％vs.11.6%,对数秩p=0.005)。
结论：失败的LA血栓在房颤和无症状LA血栓患者中并不罕见。LAAFV降低与LA血栓消退失败和不良临床结局相关。
结果：LAT研究是一项多中心观察性研究，调查经食管超声心动图（TEE）检测到的房颤（AF）和无症状LA血栓患者。在17,436例房颤患者的TEE手术中，297例患者（1.7％）患有无症状LA血栓。不包括没有随访检查的患者，我们纳入了169名基线LAAFV可用的患者.口服抗凝药物的使用从基线时的85.7%增加到最终随访时的97.0%(p<0.001)。在1年内,在76天（34-138天）内，在130例（76.9％）患者中确认了LA血栓消退。相反，26有残余的LA血栓，8人有血栓栓塞,5需要手术切除。这些血栓消退失败的患者的基线LAAFV低于成功消退的患者（18.0[15.8-22.0]vs.22.2[17.0-35.0]，p=0.003)。尽管预测能力有限(曲线下面积，0.659；p=0.001），LAAFV≤20.0cm/s(最佳截止值)显著预测LA血栓消退失败,即使在调整了潜在的混杂因素(赔率比，2.72；95%置信区间，1.22-6.09；p=0.015）。不良结局的发生率，包括缺血性卒中/全身性栓塞，大出血,LAAFV降低的患者或全因死亡显着高于LAAFV保留的患者（28.4％vs.11.6%,对数秩p=0.005)。
结论：失败的LA血栓在房颤和无症状LA血栓患者中并不罕见。LAAFV降低与LA血栓消退失败和不良临床结局相关。
