Impact of Left Atrial Appendage Morphology and Function on Thrombosis Risk in Acute Ischemic Stroke: Insights from Transesophageal Echocardiography

TL;DR

This study shows that left atrial spontaneous echo contrast and atrial fibrillation are linked to a higher risk of blood clots in stroke patients, using transesophageal echocardiography for detection.

Contribution

The study identifies two independent predictors of left atrial appendage thrombus in acute ischemic stroke patients using transesophageal echocardiography.

Findings

19 out of 171 patients (11.1%) had a left atrial appendage thrombus.

Left atrial spontaneous echo contrast was a strong predictor of thrombus formation (OR = 8).

Atrial fibrillation was also an independent predictor of thrombus (OR = 8).

Abstract

Objective: This study aims to investigate the correlation between the morphological and functional characteristics of the left atrial appendage (LAA) and the incidence of thromboembolic events by transesophageal echocardiography (TEE) in patients with acute ischemic stroke. Methods: This cross-sectional study included 171 patients with acute ischemic stroke, running from November 2022 to September 2024. Transesophageal echocardiography was performed to evaluate the presence of LAA thrombus. Multivariable logistic regression analysis was performed to identify risk factors for LAA thrombus. Results: Of the 171 patients, 19 (11.1%) were found to have LAA thrombus. Multivariable logistic regression identified two independent predictors of LAA thrombus formation: (1) left atrial spontaneous echo contrast (OR = 8, 95% CI: 3–19, p < 0.001) and (2) atrial fibrillation (OR = 8, 95% CI: 1.057–76.095, p = 0.044). Conclusions: Left atrial spontaneous echo contrast and atrial fibrillation are independent predictors of LAA thrombus in patients with acute ischemic stroke. The use of transesophageal echocardiography for early detection of LAA thrombus may help improve treatment strategies and prevent recurrent strokes.

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