{"title":"Predictors of Device-Related Thrombus After Left Atrial Appendage Occlusion: TED-F2 Score","authors":"","doi":"10.1016/j.cjco.2024.05.015","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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-F<sub>2</sub> score, included history of venous <strong>T</strong>hromboembolism (23.1% vs 5.1%, <em>P</em> = 0.01), an LAA <strong>E</strong>mptying velocity ≤ 20 cm/s (45.8% vs 18.9%, <em>P</em> = 0.01), an implant <strong>D</strong>epth > 2 cm (34.6% vs 12.8%, <em>P</em> = 0.02), and presence of A<strong>F</strong> rhythm at time of device implantation (50.0 % vs 11.5%, <em>P</em> = 0.0001). A TED-F<sub>2</sub> score of ≥ 3 was very strongly associated with DRT—odds ratio 12.5 (95% confidence interval, 3.8-41.1, <em>P</em> < 0.0001).</div></div><div><h3>Conclusions</h3><div>We propose a novel risk score to predict development of DRT after LAAO, comprising history of venous <strong>T</strong>hromboembolism, LAA <strong>E</strong>mptying velocity ≤ 20 cm/s, implant <strong>D</strong>epth > 2 cm (1 point each), and an A<strong>F</strong> rhythm at implantation (2 points). A TED-F<sub>2</sub> risk score of ≥ 3 identified patients who are at greatly elevated risk of developing DRT.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"CJC Open","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2589790X24002531","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
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.