Data_Sheet_1_Risk factors for left atrial thrombus in younger patients (aged < 65 years) with atrial fibrillation or atrial flutter: Data from the multicenter left atrial thrombus on transesophageal echocardiography (LATTEE) registry.docx

BackgroundOur aim was to assess the characteristics and to identify predictors of left atrial thrombus (LAT) in patients under age 65 with atrial fibrillation (AF) or atrial flutter (AFl).
MethodsWe conducted a subanalysis of a multicenter, prospective, observational study [the LATTEE registry]. Consecutive AF/AFl patients referred for cardioversion or ablation were enrolled.
ResultsOf the 3,109 patients included in the study, 1,276 were under age 65 (41%). Compared to non-LAT patients, those with LAT (n = 76) had higher CHA2DS2-VASc score (p < 0.001), more frequently had non-paroxysmal AF/AFl (p < 0.001), heart failure (p < 0.001), history of diabetes mellitus (p = 0.001), transient ischemic attack (p = 0.04), coronary artery disease (p = 0.02), and chronic kidney disease (p < 0.001). The LAT patients were also more often smokers (p = 0.004) and were more frequently treated with vitamin K antagonists (VKAs) (p < 0.001). Transthoracic echocardiography revealed a higher left atrial area (p < 0.001), lower left ventricular ejection fraction (LVEF) (p < 0.001), and lower value of LA appendage emptying volume in LAT than in non-LAT patients (p < 0.001). LVEF (OR 2.95; 95% CI: 1.32–6.59, p = 0.008), non-paroxysmal AF/AFl (OR 7.1; 95% CI: 2.05–24.63, p = 0.002) and treatment with VKAs (OR 4.92; 95% CI: 2.48–9.75, p < 0.001) were identified as independent predictors of LAT in younger patients.
ConclusionsOur study, which focused on younger patients with AF/AFl, indicated substantial clinical and echocardiographic differences between participants with and without LAT. In the AF/AFl patients younger than age 65, the independent predictors of LAT included non-paroxysmal AF/AFl, lower LVEF, and treatment with VKAs.

背景：本研究旨在评估年龄<65岁的心房颤动（atrial fibrillation, AF）或心房扑动（atrial flutter, AFl）患者的左心房血栓（left atrial thrombus, LAT）相关特征，并明确其独立预测因素。
方法：本研究对一项多中心前瞻性观察性研究[LATTEE注册研究]进行了亚组分析，纳入因拟行心脏复律或消融治疗而就诊的连续性AF/AFl患者。
结果：本研究纳入的3109例患者中，1276例年龄<65岁，占比41%。与无LAT患者相比，76例LAT患者的CHA₂DS₂-VASc评分更高（P<0.001），非阵发性AF/AFl、心力衰竭、糖尿病病史、短暂性脑缺血发作、冠状动脉疾病及慢性肾脏病的发生率均显著更高（P值分别为<0.001、<0.001、0.001、0.04、0.02、<0.001）。LAT患者的吸烟比例更高（P=0.004），且更常接受维生素K拮抗剂（vitamin K antagonists, VKAs）治疗（P<0.001）。经胸超声心动图检查结果显示，LAT患者的左心房面积更大（P<0.001）、左心室射血分数（left ventricular ejection fraction, LVEF）更低（P<0.001），左心耳排空容积也低于无LAT患者（P<0.001）。多因素回归分析显示，LVEF（比值比OR=2.95；95%置信区间CI：1.32~6.59，P=0.008）、非阵发性AF/AFl（OR=7.1；95%CI：2.05~24.63，P=0.002）及VKAs治疗（OR=4.92；95%CI：2.48~9.75，P<0.001）是该年轻人群发生LAT的独立预测因素。
结论：本研究聚焦AF/AFl年轻患者，结果显示合并与未合并LAT的受试者在临床特征与经胸超声心动图表现上存在显著差异。在年龄<65岁的AF/AFl患者中，LAT的独立预测因素包括非阵发性AF/AFl、较低的LVEF以及VKAs治疗。