Prädiktoren der linksatrialen Thromben und Spontanechokontrastierung bei Patienten mit Vorhofflimmern vor geplanter Kardioversion – Eine monozentrische Erfahrung – eine systematische Analyse

Predictors for left atrial thrombi and spontaneous echo contrast in patients with atrial fibrillation before planed cardioversion - A monocentric experience - A systematic analysis

von Alexandru Gabriel Bejinariu
Kumulative Dissertation
Datum der mündl. Prüfung:2018-02-06
Erschienen:2018-01-08
Betreuer:Prof. Dr. Ulrich Tebbe
Gutachter:Prof. Dr. Joachim Lotz
Gutachter:Prof. Dr. Martin Oppermann
Zum Verlinken/Zitieren: http://dx.doi.org/10.53846/goediss-6665

 

 

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Background. It is known that atrial fibrillation is associated with a higher risk for embolic events. Left atrial appendage thombi and spontaneous echocardiographic contrast (SEC) are known to positively correlate with this risk. We studied the laboratory, echocardiographic and epidemiologic parameters that could predict the left atrial thrombi and the intensity of the SEC. Methods. Between September 2013 and June 2015 we included a total of 372 patients with atrial fibrillation before planned electrical cardioversion (transesophageal guided strategy). After assessing the stroke and bleeding risks (CHA2DS2-VASc and HAS-BLED scores), we measured the concentration of the D-Dimer and B-type natriuretic peptide at the time of the transesophageal echocardiography and the left atrial volume and the ejection fraction in a transthoracic echocardiography. Results. The ejection fraction and the CHA2DS2-VASc score were identified as independent predictors of both left atrial thrombi and SEC, whereas the left atrial volume could only predict the intensity of SEC. In contrast to other studies, the studied biomarkers failed to predict the outcome. Conclusion. Only the echocardiographic and epidemiologic parameters were predictors of left atrial thrombi and SEC intensity, the studied biomarkers had no predictive power. Using clinical data and transthoracic echocardiography we can further stratify the thromboembolic risk in uncertain cases.
Keywords: thrombus; atrial fibrillation; left atrium; transoesophageal echocardiography
 
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