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Abstract：
BACKGROUND: Stroke and thromboembolism in nonvalvular atrial fibrillation (NVAF) primarily arise from thrombi or sludge in the left atrial appendage (LAA). Comprehensive insight into the characteristics of these formations is essential for effective risk assessment and management.
METHODS: We conducted a single-center retrospective observational of 176 consecutive NVAF patients with confirmed atrial/appendage thrombus or sludge determined by a pre-ablation transesophageal echocardiogram (TEE) from December 2017 to April 2019. We obtained clinical and echocardiographic characteristics, including left atrial appendage emptying velocity (LAAeV) and filling velocity (LAAfV). Data analysis focused on identifying the morphology and location of thrombus or sludge. Patients were divided into the solid thrombus and sludge groups, and the correlation between clinical and echocardiographic variables and thrombotic status was analyzed.
RESULTS: Morphological classification: In total, thrombi were identified in 78 patients, including 71 (40.3%) mass and 7 (4.0%) lamellar, while sludge was noted in 98 (55.7%). Location classification: 92.3% (72/78) of patients had thrombus confined to the LAA; 3.8% (3/78) had both LA and LAA involvement; 2.7% (2/78) had LA, LAA and RAA extended into the RA, the remained 1.2%(1/78) was isolated to RAA. 98.0% (96/98) of patients had sludge confined to the LAA; the remaining 2.0% (2/98) were present in the atrial septal aneurysm, which protrusion of interatrial septum into the RA. The thrombus and sludge groups showed low LAAeV (19.43 ± 9.59 cm/s) or LAAfV (17.40 ± 10.09 cm/s). Only LA dimension ≥ 40 mm was independently associated with the thrombus state in the multivariable model.
CONCLUSIONS: This cohort study identified rare thrombus morphology and systematically summarized the classification of thrombus morphology. The distribution of thrombus and sludge outside limited to LAA was updated, including bilateral atrial and appendage involvement and rare atrial septal aneurysm sludge. LAAeV and LAAfV were of limited value in distinguishing solid thrombus from sludge.
BACKGROUND: ChiCTR-OCH-13,003,729.
METHODS: We conducted a single-center retrospective observational of 176 consecutive NVAF patients with confirmed atrial/appendage thrombus or sludge determined by a pre-ablation transesophageal echocardiogram (TEE) from December 2017 to April 2019. We obtained clinical and echocardiographic characteristics, including left atrial appendage emptying velocity (LAAeV) and filling velocity (LAAfV). Data analysis focused on identifying the morphology and location of thrombus or sludge. Patients were divided into the solid thrombus and sludge groups, and the correlation between clinical and echocardiographic variables and thrombotic status was analyzed.
RESULTS: Morphological classification: In total, thrombi were identified in 78 patients, including 71 (40.3%) mass and 7 (4.0%) lamellar, while sludge was noted in 98 (55.7%). Location classification: 92.3% (72/78) of patients had thrombus confined to the LAA; 3.8% (3/78) had both LA and LAA involvement; 2.7% (2/78) had LA, LAA and RAA extended into the RA, the remained 1.2%(1/78) was isolated to RAA. 98.0% (96/98) of patients had sludge confined to the LAA; the remaining 2.0% (2/98) were present in the atrial septal aneurysm, which protrusion of interatrial septum into the RA. The thrombus and sludge groups showed low LAAeV (19.43 ± 9.59 cm/s) or LAAfV (17.40 ± 10.09 cm/s). Only LA dimension ≥ 40 mm was independently associated with the thrombus state in the multivariable model.
CONCLUSIONS: This cohort study identified rare thrombus morphology and systematically summarized the classification of thrombus morphology. The distribution of thrombus and sludge outside limited to LAA was updated, including bilateral atrial and appendage involvement and rare atrial septal aneurysm sludge. LAAeV and LAAfV were of limited value in distinguishing solid thrombus from sludge.
BACKGROUND: ChiCTR-OCH-13,003,729.
摘要：
背景：非瓣膜性心房颤动（NVAF）的卒中和血栓栓塞主要起因于左心耳（LAA）的血栓或淤泥。全面了解这些编队的特征对于有效的风险评估和管理至关重要。
方法：我们在2017年12月至2019年4月期间，对176例连续NVAF患者进行了单中心回顾性观察，这些患者通过消融前经食管超声心动图（TEE）确定为心房/附件血栓或污泥。我们获得了临床和超声心动图特征，包括左心耳排空速度(LAAeV)和充盈速度(LAAfV)。数据分析侧重于确定血栓或污泥的形态和位置。将患者分为固体血栓组和污泥组，并分析了临床和超声心动图变量与血栓状态之间的相关性。
结果：形态分类：总计，在78名患者中发现了血栓，包括71（40.3%）质量和7（4.0%）层状，而污泥在98（55.7%）中被注意到。部位分类：92.3%(72/78)的患者有局限于左心耳的血栓；3.8%(3/78)的患者有LA和LAA受累；2.7%(2/78)的患者有LA，LAA和RAA延伸到RA，其余1.2%(1/78)分离至RAA。98.0%(96/98)的患者有污泥局限于左心耳；其余2.0%(2/98)存在于房间隔动脉瘤中，房间隔伸入RA。血栓和污泥组显示低LAAeV（19.43±9.59cm/s）或LAAfV（17.40±10.09cm/s）。在多变量模型中，只有LA尺寸≥40mm与血栓状态独立相关。
结论：这项队列研究确定了罕见的血栓形态，并系统地总结了血栓形态的分类。更新了LAA以外的血栓和污泥的分布，包括双侧心房和附件受累和罕见的房间隔动脉瘤污泥。LAAeV和LAAfV在区分固体血栓和污泥方面的价值有限。
背景：ChiCTR-OCH-13,003,729。
方法：我们在2017年12月至2019年4月期间，对176例连续NVAF患者进行了单中心回顾性观察，这些患者通过消融前经食管超声心动图（TEE）确定为心房/附件血栓或污泥。我们获得了临床和超声心动图特征，包括左心耳排空速度(LAAeV)和充盈速度(LAAfV)。数据分析侧重于确定血栓或污泥的形态和位置。将患者分为固体血栓组和污泥组，并分析了临床和超声心动图变量与血栓状态之间的相关性。
结果：形态分类：总计，在78名患者中发现了血栓，包括71（40.3%）质量和7（4.0%）层状，而污泥在98（55.7%）中被注意到。部位分类：92.3%(72/78)的患者有局限于左心耳的血栓；3.8%(3/78)的患者有LA和LAA受累；2.7%(2/78)的患者有LA，LAA和RAA延伸到RA，其余1.2%(1/78)分离至RAA。98.0%(96/98)的患者有污泥局限于左心耳；其余2.0%(2/98)存在于房间隔动脉瘤中，房间隔伸入RA。血栓和污泥组显示低LAAeV（19.43±9.59cm/s）或LAAfV（17.40±10.09cm/s）。在多变量模型中，只有LA尺寸≥40mm与血栓状态独立相关。
结论：这项队列研究确定了罕见的血栓形态，并系统地总结了血栓形态的分类。更新了LAA以外的血栓和污泥的分布，包括双侧心房和附件受累和罕见的房间隔动脉瘤污泥。LAAeV和LAAfV在区分固体血栓和污泥方面的价值有限。
背景：ChiCTR-OCH-13,003,729。
