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Archives of cardiovascular diseases
Volume 106, n° 4
page 266 (avril 2013)
Doi : 10.1016/j.acvd.2013.03.055

Transesophageal markers of thromboembolism in non-valvular atrial fibrillation patients with a CHADS2 score=0

S. Ederhy, S. Ederhy, S. Lang, L. Boyer Chatenet, N. Haddour, C. Meuleman, G. Fleury, A. Saroumadi, F. Boccara, E. Di Angelantonio, A. Cohen
 Hôpital Saint-Antoine, Paris, France 

Background .– Transesophageal echocardiography (TEE) parameters (left atrial appendage, LAA thrombus or spontaneous echocardiographic contrast (SEC), aortic atheroma (AAA) are powerful markers of thromboembolism (TE) in non-valvular atrial fibrillation (NVAF) patients. However, the prevalence and potential impact of these abnormalities have not been evaluated in patients at very low risk of TE. We evaluated TEE-detected LASEC, thrombus and AAA in AF patients referred for cardioversion and analyzed the subgroup of patients with a CHADS2 score=0.

Patients .– Among 763 consecutive patients hospitalized for NVAF, prior to cardioversion, TEE was systematically performed within 24h after admission; 205 patients had a CHADS2 score=0. The following parameters were described: presence and severity of LASEC, LA thrombus, aortic atheroma (AAA).

Results .– Mean age was 54.5±13.5years. AF was paroxysmal in 101 patients (49.3%), persistent in 82 (40.0%) and permanent in 22 (10.7%). Transthoracic echocardiography showed LVEF<40% in 12 (5.9%) and median of mean LA area was 18 (15–23) cm2. LA thrombus was found in one patient (0.5%), LASEC in 60 (29.3%), classified as mild in 43 (21.0%), moderate in 14 (6.8%) and severe in three (1.5%). AAA was present in six patients (2.9%). The Table 1 compares some baseline characteristics in patients with (LAASEC/thrombus or aortic atheroma4mm) or without TEE abnormalities, defined as an endpoint.

In the multivariate analysis, age (OR, 1.04, 95% CI 1.01–1.07), non paroxysmal AF (OR, 3.23, 95% CI 1.54–6.78) and LA area (OR, 1.08, 95% CI 1.02–1.16) were predictors of TEE-detected LASEC/thrombus or aortic atheroma.

Conclusions .– TEE prior to cardioversion in NVAF found TEE-detected risk markers of thromboembolism (LASEC/thrombus or aortic atheroma) in one third of patients with a CHADS2 score=0.

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