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Predictors of Device-Related Thrombus After Left Atrial Appendage Occlusion: TED-F2 Score
Jiwani, Sania Morgan, Ethan Baghdadi, Sarah Smith, Ross Tabak, Carine Parikh, Riya Bajaj, Matthew Enders, Robert Uhlich, Cody Baer, Jacob
Jiwani, Sania
Morgan, Ethan
Baghdadi, Sarah
Smith, Ross
Tabak, Carine
Parikh, Riya
Bajaj, Matthew
Enders, Robert
Uhlich, Cody
Baer, Jacob
Abstract
Background
Left atrial appendage (LAA) occlusion (LAAO) is performed to prevent LAA thrombus in patients with atrial fibrillation (AF). The risk of device-related thrombus (DRT) on the atrial side of the LAAO device is approximately 4%. Identifying patients at high risk of DRT would enable closer surveillance and more-aggressive anticoagulation to prevent post-LAAO DRT-related stroke.
Methods
From the LAAO registry at The University of Kansas Medical Center, we identified patients who developed DRT. We chose 3 unmatched controls per DRT case from LAAO recipients without DRT. Predictor variables were obtained from transesophageal echocardiogram reports and/or images, transthoracic echocardiogram reports, and chart review. Implant depth was measured from the limbus of the left atrial ridge to the centre of the atrial aspect of the LAAO device, on a 45° transesophageal echocardiogram view.
Results
We identified 26 patients with DRT (aged 77.7 ± 9.7 years; 34.6% female) and selected 78 unmatched controls without DRT. Univariate predictors of DRT, comprising a novel TED-F2 score, included history of venous Thromboembolism (23.1% vs 5.1%, P = 0.01), an LAA Emptying velocity ≤ 20 cm/s (45.8% vs 18.9%, P = 0.01), an implant Depth > 2 cm (34.6% vs 12.8%, P = 0.02), and presence of AF rhythm at time of device implantation (50.0 % vs 11.5%, P = 0.0001). A TED-F2 score of ≥ 3 was very strongly associated with DRT—odds ratio 12.5 (95% confidence interval, 3.8-41.1, P < 0.0001).
Conclusions
We propose a novel risk score to predict development of DRT after LAAO, comprising history of venous Thromboembolism, LAA Emptying velocity ≤ 20 cm/s, implant Depth > 2 cm (1 point each), and an AF rhythm at implantation (2 points). A TED-F2 risk score of ≥ 3 identified patients who are at greatly elevated risk of developing DRT.
Description
A grant from the One-University Open Access Fund at the University of Kansas was used to defray the author's publication fees in this Open Access journal. The Open Access Fund, administered by librarians from the KU, KU Law, and KUMC libraries, is made possible by contributions from the offices of KU Provost, KU Vice Chancellor for Research & Graduate Studies, and KUMC Vice Chancellor for Research. For more information about the Open Access Fund, please see http://library.kumc.edu/authors-fund.xml.
Date
2024-06-14
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Elsevier
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Citation
Sania Jiwani, Ethan Morgan, Sarah Baghdadi, Ross Smith, Carine Tabak, Riya Parikh, Matthew Bajaj, Robert Enders, Cody Uhlich, Jacob Baer, Christopher Harvey, Jeanine Swope, Stephanie Stokka, Ashutosh Bapat, Kamal Gupta, Mark A. Wiley, Seth H. Sheldon, Raghuveer Dendi, Madhu Reddy, Eric Hockstad, Prasad Gunasekaran, Amit Noheria,
Predictors of Device-Related Thrombus After Left Atrial Appendage Occlusion: TED-F2 Score,
CJC Open,
2024, ISSN 2589-790X, https://doi.org/10.1016/j.cjco.2024.05.015.