A new risk model of predicting left atrial thrombus/spontaneous echo contrast using left atrial diameter and brain natriuretic peptide in patients with paroxysmal atrial fibrillation

Abstract Objective To develop a new model for predicting left atrial thrombus (LAT) or spontaneous echo contrast (SEC) and explore the influence from left atrial diameter (LAD) and brain natriuretic peptide (BNP) to LAT/SEC in patients with paroxysmal atrial fibrillation (PAF). Methods A total of 434 consecutive PAF patients who underwent transesophageal echocardiography (TEE) were divided into LAT/SEC group and No LAT/SEC group between January 2019 and December 2021. Then, we retrospectively analyzed the baseline clinical characteristics, routine laboratory and echocardiographic parameters. Results Among the 434 PAF patients, 45 patients had LAT/SEC (10.4%, 45/434). Multivariate logistic regression analysis identified LAD [odds ratio (OR) = 1.202, 95% confidence interval (CI): 1.107–1.305, P < 0.001] and BNP (OR = 1.001, 95% CI: 1.000–1.003, P = 0.035) were independent risk factors of LAT/SEC. The optimal cut-off values when predicting LAT/SEC using LAD and BNP were 41.5 mm and 62.6 pg/mL, respectively. A model of combining LAD, BNP and CHA 2 DS 2 -VASc score significantly improved discrimination in LAT/SEC. In medium risk group, the incidence of LAT/SEC (22.6%) rose significantly when LAD or BNP was higher than cut-off values. Conclusion LAD and BNP, as independent predictors of LAT/SEC, combine with CHA 2 DS 2 -VASc score may better help thromboembolic risk stratification in PAF patients. Especially if LAD or BNP was higher than their cut-off values, the risk of cardioembolic stroke would rise accompanied by the increased incidence of LAT/SEC in patients with medium risk group.