作者
Jules Mesnier,Trevor Simard,Richard G. Jung,Kyle Lehenbauer,Kerstin Piayda,Radosław Pracoń,Gregory G. Jackson,Eduardo Flores‐Umanzor,Laurent Faroux,Kasper Korsholm,Julian Chun,Shaojie Chen,Moniek Maarse,Kristi Montrella,Zakeih Chaker,Jocelyn N. Spoon,Luigi Emilio Pastormerlo,Felix Meincke,Abhishek C. Sawant,Carmen Moldovan,Mohammed Qintar,Mehmet K. Aktaş,Luca Branca,Andrea Radinovic,Pradhum Ram,Rayan El‐Zein,Thomas Flautt,Wern Yew Ding,Bassel Sayegh,Tomas Benito‐González,Oh Hyun Lee,Solomon O. Badejoko,Christina Paitazoglou,Nabeela Karim,Ahmed Zaghloul,Himanshu Agarwal,Rachel Kaplan,Oluseun Alli,Aamir Ahmed,Hussam Suradi,Bradley P. Knight,Venkata Alla,Sidakpal Panaich,Tom Wong,Martin Bergmann,Rashaad Chothia,Jung Sun Kim,Armando Pérez de Prado,Raveen Bazaz,Dhiraj Gupta,Miguel Valderrábano,Carlos E. Sanchez,Mikhael F. El‐Chami,Patrizio Mazzone,Marianna Adamo,Fred S. Ling,Dee Dee Wang,William W. O’Neill,Wojtek Wojakowski,Ashish Pershad,Sérgio Berti,Daniel B. Spoon,Akram Kawsara,George Jabbour,Lucas V.A. Boersma,Boris Schmidt,Jens Erik Nielsen‐Kudsk,Xavier Freixa,Christopher R. Ellis,Laurent Fauchier,Marcin Demkow,Horst Sievert,Michael L. Main,Benjamin Hibbert,David R. Holmes,Mohamad Alkhouli,Josep Rodés‐Cabau
摘要
Scarce data exist on the evolution of device-related thrombus (DRT) after left atrial appendage closure (LAAC).This study sought to assess the incidence, predictors, and clinical impact of persistent and recurrent DRT in LAAC recipients.Data were obtained from an international multicenter registry including 237 patients diagnosed with DRT after LAAC. Of these, 214 patients with a subsequent imaging examination after the initial diagnosis of DRT were included. Unfavorable evolution of DRT was defined as either persisting or recurrent DRT.DRT resolved in 153 (71.5%) cases and persisted in 61 (28.5%) cases. Larger DRT size (OR per 1-mm increase: 1.08; 95% CI: 1.02-1.15; P = 0.009) and female (OR: 2.44; 95% CI: 1.12-5.26; P = 0.02) were independently associated with persistent DRT. After DRT resolution, 82 (53.6%) of 153 patients had repeated device imaging, with 14 (17.1%) cases diagnosed with recurrent DRT. Overall, 75 (35.0%) patients had unfavorable evolution of DRT, and the sole predictor was average thrombus size at initial diagnosis (OR per 1-mm increase: 1.09; 95% CI: 1.03-1.16; P = 0.003), with an optimal cutoff size of 7 mm (OR: 2.51; 95% CI: 1.39-4.52; P = 0.002). Unfavorable evolution of DRT was associated with a higher rate of thromboembolic events compared with resolved DRT (26.7% vs 15.1%; HR: 2.13; 95% CI: 1.15-3.94; P = 0.02).About one-third of DRT events had an unfavorable evolution (either persisting or recurring), with a larger initial thrombus size (particularly >7 mm) portending an increased risk. Unfavorable evolution of DRT was associated with a 2-fold higher risk of thromboembolic events compared with resolved DRT.