Discussion
peripheral arterial disease, chronic kidney disease, LAA thrombi, thromboembolic, LAA thrombus, fibrosis, coagulation pathologies, ischemic stroke, thrombus, thrombi, renal dysfunction, diabetes
SUDDEN CARDIAC DEATH, PERIPHERAL ARTERIAL DISEASE, THROMBOEMBOLIC EVENT, HEART DISEASE, KIDNEY DISEASE, INFLAMMATION, FIBROSIS, ISCHEMIC STROKE, THROMBUS, THROMBI, DIABETES
To our knowledge, we not only present the largest cohort of patients with LAA thrombi, but also provide a comprehensive assessment of a large number of clinical, echocardiographic and laboratory parameters, some of which previously shown in smaller studies (13–126 patients) to be involved in thrombus formationThrombus formation occurred primarily in patients with persistent or permanent AF. Two studiesInterstitial fibrosis promoted by elevated left-sided filling pressures was shown to result in LA stiffness and impaired LA contractilityWe found that markers of cardiac strain and damage like NT-pro BNP and hs troponin T were markedly elevated in patients with LAA thrombi, an observation also reported by previous studiesIn our study, a poorly controlled diabetes and advanced renal dysfunction were associated with LAA thrombus persistence. Numerous studies indicated that both conditions were associated with increased inflammation, coagulation pathologies and atrial fibrosisSo far, fibrinogen has not been shown to be associated with LAA thrombus formation before. In patients with advanced chronic kidney disease, fibrinogen levels were an independent predictor of mortalityFew studies have addressed the question to what extent LAA thrombi dissolve and which factors other than oral anticoagulants might be involved in this process. Consistent with other studiesA number of studies showed that flow velocities ≤ 20 cm/s were associated with LAA thrombus formation and a higher incidence of thromboembolic eventsAt last, we show for the first time that 10-year survival was greatly reduced in patients with LAA thrombi compared to those with no thrombi. 10-year survival in patients with persistent LAA thrombi was also worse compared to those with dissolved thrombi. Differences in survival were still apparent when groups were compared to an age-and sex-matched general population. Although, patients with LAA thrombi have a higher burden of comorbidities that could account for observed differences, presence of LAA thrombi may further contribute to mortality by thromboembolic events. AF was shown to be associated with an increased risk of all-cause mortality, cardiovascular mortality, ischemic stroke and heart disease, sudden cardiac death, heart failure, chronic kidney disease and peripheral arterial disease