Predictors of Device-Related Thrombus After Left Atrial Appendage Occlusion: TED-F2 Score

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS CJC Open Pub Date : 2024-10-01 DOI:10.1016/j.cjco.2024.05.015
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Abstract

Background

Left atrial appendage (LAA) occlusion (LAAO) is performed to prevent LAA thrombus in patients with atrial fibrillation (AF). The risk of device-related thrombus (DRT) on the atrial side of the LAAO device is approximately 4%. Identifying patients at high risk of DRT would enable closer surveillance and more-aggressive anticoagulation to prevent post-LAAO DRT-related stroke.

Methods

From the LAAO registry at The University of Kansas Medical Center, we identified patients who developed DRT. We chose 3 unmatched controls per DRT case from LAAO recipients without DRT. Predictor variables were obtained from transesophageal echocardiogram reports and/or images, transthoracic echocardiogram reports, and chart review. Implant depth was measured from the limbus of the left atrial ridge to the centre of the atrial aspect of the LAAO device, on a 45° transesophageal echocardiogram view.

Results

We identified 26 patients with DRT (aged 77.7 ± 9.7 years; 34.6% female) and selected 78 unmatched controls without DRT. Univariate predictors of DRT, comprising a novel TED-F2 score, included history of venous Thromboembolism (23.1% vs 5.1%, P = 0.01), an LAA Emptying velocity ≤ 20 cm/s (45.8% vs 18.9%, P = 0.01), an implant Depth > 2 cm (34.6% vs 12.8%, P = 0.02), and presence of AF rhythm at time of device implantation (50.0 % vs 11.5%, P = 0.0001). A TED-F2 score of ≥ 3 was very strongly associated with DRT—odds ratio 12.5 (95% confidence interval, 3.8-41.1, P < 0.0001).

Conclusions

We propose a novel risk score to predict development of DRT after LAAO, comprising history of venous Thromboembolism, LAA Emptying velocity ≤ 20 cm/s, implant Depth > 2 cm (1 point each), and an AF rhythm at implantation (2 points). A TED-F2 risk score of ≥ 3 identified patients who are at greatly elevated risk of developing DRT.
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左心房阑尾闭塞术后器械相关血栓的预测因素 - TED-F2 评分
背景对心房颤动(房颤)患者实施左心房阑尾(LAA)闭塞术(LAAO)是为了防止 LAA 血栓形成。LAAO 装置心房侧发生装置相关血栓 (DRT) 的风险约为 4%。方法我们从堪萨斯大学医学中心的 LAAO 登记册中确定了发生 DRT 的患者。我们从无 DRT 的 LAAO 受者中为每个 DRT 病例选择了 3 个不匹配的对照。预测变量来自经食道超声心动图报告和/或图像、经胸超声心动图报告以及病历审查。植入深度是在 45° 经食道超声心动图视图上从左心房嵴边缘到 LAAO 装置心房侧中心测量的。DRT的单变量预测因素包括新的TED-F2评分,包括静脉血栓栓塞史(23.1% vs 5.1%,P = 0.01)、LAA排空速度≤20 cm/s(45.8% vs 18.9%,P = 0.01)、植入深度大于2 cm(34.6% vs 12.8%,P = 0.02)和植入装置时存在房颤节律(50.0% vs 11.5%,P = 0.0001)。结论我们提出了一种新的风险评分方法来预测 LAAO 后 DRT 的发生,包括静脉血栓栓塞史、LAA 排空速度≤ 20 cm/s、植入深度≥2 cm(各 1 分)和植入时存在房颤节律(2 分)。TED-F2 风险评分≥ 3 分的患者罹患 DRT 的风险极高。
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来源期刊
CJC Open
CJC Open Medicine-Cardiology and Cardiovascular Medicine
CiteScore
3.30
自引率
0.00%
发文量
143
审稿时长
60 days
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