CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 4, September/October 2023 AFRICA 231 Application of computed tomographic angiography and echocardiography in predicting left atrial appendage thrombosis in patients with non-valvular atrial fibrillation Xiaodan Wu, Fan Sun, Shoucheng Ma, Zhichen Wang, Shenghai Xu Abstract Aim: We aimed to explore the application of computed tomographic angiography (CTA) and echocardiography in predicting left atrial appendage (LAA) thrombosis in patients with non-valvular atrial fibrillation. Methods: The clinical data of 164 atrial fibrillation patients receiving cardiac CTA and real-time three-dimensional transoesophageal echocardiography (RT-3D-TEE) were retrospectively analysed. The patients were divided into group A (anticoagulant treatment group, n = 112) and group B (selective anticoagulant treatment group, n = 52) according to the CHA2DS2-VASc score, which scored for the presence or absence of congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke/transient ischaemic attack, vascular disease, age 65–74 years and gender (female). The CHA2DS2-VASc score was used to predict risk of thromboembolism from atrial fibrillation. The correlations of CHA2DS2-VASc score with CTA-based LAA classification and RT-3D-TEE measurement parameters were explored using Spearman’s analysis. Receiver operating characteristic (ROC) curves were plotted to explore the predictive value of CTA and RT-3D-TEE for LAA thrombus. Results: There were significant differences in age, disease course, hypertension, diabetes mellitus, coronary heart disease, heart failure, stroke/transient ischaemic attack/thromboembolism, vascular disease, B-type natriuretic peptide and serum uric acid levels, CHA2DS2-VASc score, LAA classification, left ventricular ejection fraction (LVEF), left atrial diameter (LAD), maximum diameter of LAA orifice, minimum diameter of LAA orifice and LAA length (p < 0.05). CHA2DS2VASc score was positively correlated with cauliflower LAA, LAD, maximum diameter of LAA orifice, minimum diameter of LAA orifice and LAA length, and negatively correlated with LVEF (p < 0.001). ROC curve analysis indicated that CTA, RT-3D-TEE and CHA2DS2-VASc score had similar predictive values for risk of LAA thrombosis in atrial fibrillation patients, with the areas under the curve being 0.778, 0.814 and 0.792, respectively. Conclusion: Both CTA and RT-3D-TEE had high predictive values for LAA thrombosis in atrial fibrillation patients. Keywords: computed tomographic angiography, echocardiography, non-valvular atrial fibrillation, left atrial appendage, thrombosis Submitted 15/3/22; accepted 6/9/22 Published online 16/11/22 Cardiovasc J Afr 2023; 34: 231–236 www.cvja.co.za DOI: 10.5830/CVJA-2022-052 Non-valvular atrial fibrillation is a common type of arrhythmia that frequently occurs in elderly people.1 The atrial activation rate can be up to 300–600 beats/minute during an atrial fibrillation episode, leading to haemodynamic disorder in the cardiac cavity, and finally resulting in thrombus therein.2 Cerebral stroke or peripheral arterial embolism induced by atrial thrombus is the most harmful complication of atrial fibrillation.3 The left atrial appendage (LAA) is a high-incidence site of thrombosis in atrial fibrillation patients due to its special structure and function,4 therefore predicting LAA thrombosis in patients with atrial fibrillation is of significant importance for prevention and treatment of the disease. Presence or absence of congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke/transient ischaemic attack, vascular disease, age 65–74 years and female gender were scored with the CHA2DS2VASc score and patients were placed into two groups for analysis. The CHA2DS2-VASc score for thromboembolism risk from atrial fibrillation, a clinical tool commonly used to assess the risk of atrial fibrillation-induced cerebral stroke or thromboembolism, is able to guide risk stratification and prophylactic treatment, characterised by simple manipulation and easy implementation. However, it is rarely used for the cardiac structure.5 Computed tomographic angiography (CTA) can clearly display details of the blood vessels, heart and other structures, therefore it is often adopted to help understand the anatomical structure of the LAA before percutaneous LAA occlusion.6 As one of the routine examination items for atrial fibrillation patients, real-time three-dimensional transoesophageal echocardiography (RT-3D-TEE) can be employed to observe Department of Ultrasound, Shenzhen University General Hospital, Shenzhen, China Xiaodan Wu, MD, wuxdsugh@shu-edu.cn Department of Ultrasound, Affiliated Hospital of Beihua University, Jilin, China Fan Sun, MD Department of Radiology, Jilin City TCM-WM Hospital, Jilin, China Shoucheng Ma, MD Department of Cardiovascular Surgery, Jilin Central General Hospital, Jilin, China Zhichen Wang, MD Department of Ultrasound, Jilin Longtan District Tiedong Hospital, Jilin, China Shenghai Xu, MD
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