Incremental diagnostic role of left atrial strain analysis in thrombotic risk assessment of nonvalvular atrial fibrillation patients planned for electrical cardioversion

<p>Raw data related to the article</p> <p>Abstract<br> During the COVID-19 pandemic, transesophageal echocardiography (TEE) for left atrial appendage thrombosis (LAAT)<br> detection should be limited to situations of absolute necessity. We sought to identify the main conventional and functional<br> echocardiographic parameters associated with LAAT on TEE in non-valvular atrial fibrillation (NVAF) patients planned<br> for electrical cardioversion (ECV). This retrospective study included 125 consecutive NVAF patients (71.5&plusmn;7.8 yrs, 75<br> males), who underwent TEE at our Institution between April 2016 and January 2020, to exclude LAAT before scheduled<br> ECV. All patients underwent a transthoracic echocardiography (TTE) implemented with speckle tracking echocardiography<br> (STE) analysis of left atrial (LA) strain and strain rate (SR) parameters. 28% of patients were diagnosed with LAAT, while<br> 72% without LAAT. Compared to controls, patients with LAAT had significantly higher CHA2DS2-<br> Vasc Score and average<br> E/e&rsquo; ratio, and significantly lower left ventricular ejection fraction (LVEF). Moreover, LA-peak positive global atrial strain<br> (GSA+) and LA-SR parameters were significantly reduced in patients with LAAT. Multivariate logistic regression revealed<br> that, differently from CHA2DS2-<br> Vasc Score, LVEF (OR 0.88, 95%CI 0.81&ndash;0.97, p = 0.01), average E/e&rsquo; ratio (OR 2.36,<br> 95%CI 1.41&ndash;3.98, p = 0.001), and LA-GSA+ (OR 0.57, 95%CI 0.36-0-90, p = 0.01) were independently associated with<br> LAAT. LA-GSA+ (optimal cut-off &le; 9.1%, AUC 0.95) showed the highest diagnostic performance. Finally, a strong linear<br> correlation of LA peak-to-peak SR with both LA appendage filling (r = 0.86) and emptying (r = 0.83) velocities was demonstrated.<br> TTE implemented with STE analysis of LA mechanics improves thrombotic risk assessment of NVAF patients.</p>