Conclusions
right ventricular dysfunction, left ventricular dysfunction, LAA thrombi, LAA thrombus, renal and heart failure, elevated pulmonary pressures, thrombi, heart failure, renal dysfunction, diabetes
LEFT VENTRICULAR DYSFUNCTION, RENAL FAILURE, RIGHT VENTRICULAR DYSFUNCTION, THROMBI, HEART FAILURE, DIABETES
LAA thrombus formation is a multifactorial process with numerous factors amplifying each other in a complex interplay resulting over time in irreversible structural changes of the atrial wall. This study extended current knowledge by following new findings:Prevalence of LAA thrombi is associated with increasing concentrations of inflammatory parameters and markers of cardiac strain as well as declining renal function, pointing to a dynamic process of worsening organ functions. Fibrinogen has not shown before to be associated with LAA thrombus formation and persistence.Comparison of patients who dissolved their LAA thrombi versus those who did not, was not done before. Factors identified to be associated with LAA thrombus persistence despite effective oral anticoagulation were badly controlled diabetes, advanced renal failure, high levels of troponin T and fibrinogen, as well as indicators of right ventricular dysfunction most likely being a result of long lasting left ventricular dysfunction and elevated pulmonary pressures.Increases of LAA flow velocities in patients with LAA thrombi while still in AF predicted LAA thrombus resolution.Short term success in restoring sinus rhythm in patients with dissolved thrombi was high, but significantly lower as compared to patients with no LAA thrombi.Presence of a LAA thrombus was associated with a markedly increased all-cause mortality compared to patients without LAA thrombi even when compared to age- and sex-matched groups of a general population. Patient who dissolved their LAA thrombi (over 50%) had a better long-term prognosis than those with persistent LAA thrombi.These results have important clinical implications. LAA thrombi, especially when persisting, are indicators for worse prognosis and associated with advanced renal and heart failure. Cardiovascular risk factors identified to play a role in LAA thrombus formation should be treated early and aggressively. State-of-the art device- and medical therapy needs to be applied to prevent heart failure and renal dysfunction from further deterioration. However, LAA thrombus is not an irreversible fate in a number of patients but should encourage physicians to intensify available treatment options.