Symptomatic vs. non-symptomatic device-related thrombus after LAAC : a sub-analysis from the multicenter EUROC-DRT registry
Vij, Vivian (University Hospital Bonn (Bonn, Alemanya))
Cruz-González, Ignacio (Instituto de Investigación de Salamanca (Salamanca, Castella i LLeó))
Galea, Roberto (University Hospital Bern)
Piayda, Kerstin (CardioVasculäres Centrum (Frankfurt, Alemanya))
Nelles, Dominik (University Hospital Bonn (Bonn, Alemanya))
Vogt, Lara (University Hospital Bonn (Bonn, Alemanya))
Gloekler, Steffen (University Hospital Bern)
Fürholz, Monika (University Hospital Bern)
Meier, Bernhard (University Hospital Bern)
Räber, Lorenz (University Hospital Bern)
O'Hara, Gilles (Laval University (Quevec, Canadà))
Arzamendi, Dabit (Institut d'Investigació Biomèdica Sant Pau)
Agudelo Montañez, Victor Hugo (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Asmarats, Lluís (Institut d'Investigació Biomèdica Sant Pau)
Freixa, Xavier (Hospital Clínic i Provincial de Barcelona)
Flores Umanzor, Eduardo Josué (Hospital Clínic i Provincial de Barcelona)
De Backer, Ole (University Hospital Copenhagen (Copenhaguen, Dinamarca))
Sondergaard, Lars (University Hospital Copenhagen (Copenhaguen, Dinamarca))
Nombela-Franco, Luís (Hospital Clínico San Carlos (Madrid))
McInerney, Angela (Hospital Clínico San Carlos (Madrid))
Salinas, Pablo (Hospital Clínico San Carlos (Madrid))
Korsholm, Kasper (Aarhus University Hospital (Aarhus, Dinamarca))
Nielsen-Kudsk, Jens Erik (Aarhus University Hospital (Aarhus, Dinamarca))
Afzal, Shazia (University Hospital of Düsseldorf (Düsseldorf, Alemanya))
Zeus, Tobias (University Hospital of Düsseldorf (Düsseldorf, Alemanya))
Operhalski, Felix (Agaplesion Bethanien Krankenhaus. CBB (Frankfurt, Alemanya))
Schmidt, Boris (Agaplesion Bethanien Krankenhaus. CBB (Frankfurt, Alemanya))
Montalescot, Gilles (Sorbonne University (París, França))
Guedeney, Paul (Sorbonne University (París, França))
Iriart, Xavier (University Hospital Bordeaux (Bordeus, França))
Miton, Noelie (University Hospital Bordeaux (Bordeus, França))
Saw, Jacqueline (Vancouver General Hospital (Vancouver, Canadà))
Gilhofer, Thomas (University Hospital Zurich (Zúric, Suïssa))
Fauchier, Laurent (University Hospital Tours (Tours, França))
Veliqi, Egzon (St. Georg Hospital Hamburg (Hamburg, Alemanya))
Meincke, Felix (St. Georg Hospital Hamburg (Hamburg, Alemanya))
Petri, Nils (University Hospital Würzburg)
Nordbeck, Peter (University Hospital Würzburg)
Gonzalez Ferreiro, Rocío (Instituto de Investigación de Salamanca (Salamanca, Castella i Lleó))
Bhatt, Deepak L. (Mount Sinai Hospital (Nova York, Estats Units d'Amèrica))
Laricchia, Alessandra (Humanitas Research Hospital IRCCS (Rozzano, Itàlia))
Mangieri, Antonio (Humanitas Research Hospital IRCCS (Rozzano, Itàlia))
Omran, Heyder (Marienkrankenhaus (Bonn, Alemanya))
Schrickel, Jan Wilko (University Hospital Bonn (Bonn, Alemanya))
Rodes-Cabau, Josep (Laval University (Quebec, Canadà))
Nickenig, Georg (University Hospital Bonn (Bonn, Alemanya))
Sievert, Horst (CardioVasculäres Centrum (Frankfurt, Alemanya))
Sedaghat, Alexander (Rhein-Ahr-Cardio (Alemanya))
Universitat Autònoma de Barcelona

Data:	2023
Resum:	Device-related thrombus (DRT) after left atrial appendage closure (LAAC) is associated with adverse outcomes, i. e. ischemic stroke or systemic embolism (SE). Data on predictors of stroke/SE in the context of DRT are limited. This study aimed to identify predisposing factors for stroke/SE in DRT patients. In addition, the temporal connection of stroke/SE to DRT diagnosis was analyzed. The EUROC-DRT registry included 176 patients, in whom DRT after LAAC were diagnosed. Patients with symptomatic DRT, defined as stroke/SE in the context of DRT diagnosis, were compared against patients with non-symptomatic DRT. Baseline characteristics, anti-thrombotic regimens, device position, and timing of stroke/SE were compared. Stroke/SE occurred in 25/176 (14. 2%) patients diagnosed with DRT (symptomatic DRT). Stroke/SE occurred after a median of 198 days (IQR 37-558) after LAAC. In 45. 8% stroke/SE occurred within one month before/after DRT diagnosis (DRT-related stroke). Patients with symptomatic DRT had lower left ventricular ejection fractions (50. 0 ± 9. 1% vs. 54. 2 ± 11. 0%, p = 0. 03) and higher rates of non-paroxysmal atrial fibrillation (84. 0% vs. 64. 9%, p = 0. 06). Other baseline parameters and device positions were not different. Most ischemic events occurred among patients with single antiplatelet therapy (50%), however, stroke/SE was also observed under dual antiplatelet therapy (25%) or oral anticoagulation (20%). Stroke/SE are documented in 14. 2% and occur both in close temporal relation to the DRT finding and chronologically independently therefrom. Identification of risk factors remains cumbersome, putting all DRT patients at substantial risk for stroke/SE. Further studies are necessary to minimize the risk of DRT and ischemic events. Graphical Abstract: [Figure not available: see fulltext. ].
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Atrial fibrillation ; Device-related thrombus ; Left atrial appendage closure ; Stroke
Publicat a:	Clinical Research in Cardiology, Vol. 112 Núm. 12 (december 2023) , p. 1790-1799, ISSN 1861-0692

DOI: 10.1007/s00392-023-02237-w
PMID: 37294311

10 p, 1023.6 KB

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