Clinical and echocardiographic risk factors for device-related thrombus after left atrial appendage closure: an analysis from the multicenter EUROC-DRT registry

Vivian Vij; Kerstin Piayda; Dominik Nelles; Steffen Gloekler; Roberto Galea; Monika Fürholz; Bernhard Meier; Marco Valgimigli; Gilles O'Hara; Dabit Arzamendi; Victor Agudelo; Lluis Asmarats; Xavier Freixa; Eduardo Flores-Umanzor; Ole De Backer; Lars Søndergaard; Luis Nombela-Franco; Angela McInerney; Kasper Korsholm; Jens Erik Nielsen-Kudsk; Shazia Afzal; Tobias Zeus; Felix Operhalski; Boris Schmidt; Gilles Montalescot; Paul Guedeney; Xavier Iriart; Noelie Miton; Jacqueline Saw; Thomas Gilhofer; Laurent Fauchier; Egzon Veliqi; Felix Meincke; Nils Petri; Peter Nordbeck; Dmitrii Ognerubov; Evgeny Merkulov; Ignacio Cruz-González; Rocio Gonzalez-Ferreiro; Deepak L Bhatt; Alessandra Laricchia; Antonio Mangieri; Heyder Omran; Jan Wilko Schrickel; Josep Rodes-Cabau; Horst Sievert; Georg Nickenig; Alexander Sedaghat

doi:10.1007/s00392-022-02065-4

Clinical and echocardiographic risk factors for device-related thrombus after left atrial appendage closure: an analysis from the multicenter EUROC-DRT registry

Vivian Vij, Kerstin Piayda, Dominik Nelles, Steffen Gloekler, Roberto Galea, Monika Fürholz, Bernhard Meier, Marco Valgimigli, Gilles O'Hara, Dabit Arzamendi, Victor Agudelo, Lluis Asmarats, Xavier Freixa, Eduardo Flores-Umanzor, Ole De Backer, Lars Søndergaard, Luis Nombela-Franco, Angela McInerney, Kasper Korsholm, Jens Erik Nielsen-KudskShazia Afzal, Tobias Zeus, Felix Operhalski, Boris Schmidt, Gilles Montalescot, Paul Guedeney, Xavier Iriart, Noelie Miton, Jacqueline Saw, Thomas Gilhofer, Laurent Fauchier, Egzon Veliqi, Felix Meincke, Nils Petri, Peter Nordbeck, Dmitrii Ognerubov, Evgeny Merkulov, Ignacio Cruz-González, Rocio Gonzalez-Ferreiro, Deepak L Bhatt, Alessandra Laricchia, Antonio Mangieri, Heyder Omran, Jan Wilko Schrickel, Josep Rodes-Cabau, Horst Sievert, Georg Nickenig, Alexander Sedaghat^*

^*Corresponding author for this work

Department of Cardiology

26 Citations (Scopus)

Abstract

BACKGROUND: Data on Device-related Thrombus (DRT) after left atrial appendage closure (LAAC) remain scarce. This study aimed to investigate risk factors for DRT from centers reporting to the EUROC-DRT registry.

METHODS: We included 537 patients (112 with DRT and 425 without DRT) who had undergone LAAC between 12/2008 and 04/2019. Baseline and implantation characteristics, anti-thrombotic treatment and clinical outcomes were compared between both groups in uni- and multivariate analyses. Additional propensity-score matching (PSM) was conducted to focus on the role of implantation characteristics.

RESULTS: Patients with DRT showed higher rates of previous stroke/transient ischemic attack (TIA) (49.1% vs. 34.7%, p < 0.01), spontaneous echocardiographic contrast (SEC) (44.9% vs. 27.7%, p < 0.01) and lower left atrial appendage (LAA) peak emptying velocity (35.4 ± 18.5 vs. 42.4 ± 18.0 cm/s, p = 0.02). Occluders implanted in DRT patients were larger (25.5 ± 3.8 vs. 24.6 ± 3.5 mm, p = 0.03) and implanted deeper in the LAA (mean depth: 7.6 ± 4.7 vs. 5.7 ± 4.7 mm, p < 0.01). Coverage of the appendage ostium was achieved less often in DRT patients (69.5% vs. 81.5%, p < 0.01), while DRT patients were less frequently on oral anticoagulation (7.1% vs. 16.7%, p < 0.01). Multivariate analysis identified age, prior stroke/TIA and SEC as independent risk factors for DRT. After PSM, implantation depth was found to be predictive. Rates of stroke/TIA were higher in DRT patients (13.5% vs. 3.8%, Hazard Ratio: 4.21 [95%-confidence interval: 1.88-9.49], p < 0.01).

CONCLUSIONS: DRT after LAAC is associated with adverse outcome and appears to be of multifactorial origin, depending on patient characteristics, anticoagulation regimen and device position.

Original language	English
Journal	Clinical research in cardiology : official journal of the German Cardiac Society
Volume	111
Issue number	11
Pages (from-to)	1276-1285
Number of pages	10
ISSN	1861-0684
DOIs	https://doi.org/10.1007/s00392-022-02065-4
Publication status	Published - Nov 2022

Keywords

Anticoagulants/therapeutic use
Atrial Appendage/diagnostic imaging
Atrial Fibrillation/complications
Echocardiography
Humans
Ischemic Attack, Transient
Registries
Risk Factors
Stroke/diagnosis
Thrombosis/diagnosis
Treatment Outcome
Stroke
Atrial fibrillation
Left atrial appendage closure
Device-related thrombus

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Vij, V., Piayda, K., Nelles, D., Gloekler, S., Galea, R., Fürholz, M., Meier, B., Valgimigli, M., O'Hara, G., Arzamendi, D., Agudelo, V., Asmarats, L., Freixa, X., Flores-Umanzor, E., De Backer, O., Søndergaard, L., Nombela-Franco, L., McInerney, A., Korsholm, K., ... Sedaghat, A. (2022). Clinical and echocardiographic risk factors for device-related thrombus after left atrial appendage closure: an analysis from the multicenter EUROC-DRT registry. Clinical research in cardiology : official journal of the German Cardiac Society, 111(11), 1276-1285. https://doi.org/10.1007/s00392-022-02065-4

Clinical and echocardiographic risk factors for device-related thrombus after left atrial appendage closure: an analysis from the multicenter EUROC-DRT registry. / Vij, Vivian; Piayda, Kerstin; Nelles, Dominik et al.
In: Clinical research in cardiology : official journal of the German Cardiac Society, Vol. 111, No. 11, 11.2022, p. 1276-1285.

Research output: Contribution to journal › Journal article › Research › peer-review

Vij, V, Piayda, K, Nelles, D, Gloekler, S, Galea, R, Fürholz, M, Meier, B, Valgimigli, M, O'Hara, G, Arzamendi, D, Agudelo, V, Asmarats, L, Freixa, X, Flores-Umanzor, E, De Backer, O , Søndergaard, L, Nombela-Franco, L, McInerney, A, Korsholm, K, Nielsen-Kudsk, JE, Afzal, S, Zeus, T, Operhalski, F, Schmidt, B, Montalescot, G, Guedeney, P, Iriart, X, Miton, N, Saw, J, Gilhofer, T, Fauchier, L, Veliqi, E, Meincke, F, Petri, N, Nordbeck, P, Ognerubov, D, Merkulov, E, Cruz-González, I, Gonzalez-Ferreiro, R, Bhatt, DL, Laricchia, A, Mangieri, A, Omran, H, Schrickel, JW, Rodes-Cabau, J, Sievert, H, Nickenig, G & Sedaghat, A 2022, 'Clinical and echocardiographic risk factors for device-related thrombus after left atrial appendage closure: an analysis from the multicenter EUROC-DRT registry', Clinical research in cardiology : official journal of the German Cardiac Society, vol. 111, no. 11, pp. 1276-1285. https://doi.org/10.1007/s00392-022-02065-4

@article{c9122b4d68e0435da816c25d1aa13c63,

title = "Clinical and echocardiographic risk factors for device-related thrombus after left atrial appendage closure: an analysis from the multicenter EUROC-DRT registry",

abstract = "BACKGROUND: Data on Device-related Thrombus (DRT) after left atrial appendage closure (LAAC) remain scarce. This study aimed to investigate risk factors for DRT from centers reporting to the EUROC-DRT registry.METHODS: We included 537 patients (112 with DRT and 425 without DRT) who had undergone LAAC between 12/2008 and 04/2019. Baseline and implantation characteristics, anti-thrombotic treatment and clinical outcomes were compared between both groups in uni- and multivariate analyses. Additional propensity-score matching (PSM) was conducted to focus on the role of implantation characteristics.RESULTS: Patients with DRT showed higher rates of previous stroke/transient ischemic attack (TIA) (49.1\% vs. 34.7\%, p < 0.01), spontaneous echocardiographic contrast (SEC) (44.9\% vs. 27.7\%, p < 0.01) and lower left atrial appendage (LAA) peak emptying velocity (35.4 ± 18.5 vs. 42.4 ± 18.0 cm/s, p = 0.02). Occluders implanted in DRT patients were larger (25.5 ± 3.8 vs. 24.6 ± 3.5 mm, p = 0.03) and implanted deeper in the LAA (mean depth: 7.6 ± 4.7 vs. 5.7 ± 4.7 mm, p < 0.01). Coverage of the appendage ostium was achieved less often in DRT patients (69.5\% vs. 81.5\%, p < 0.01), while DRT patients were less frequently on oral anticoagulation (7.1\% vs. 16.7\%, p < 0.01). Multivariate analysis identified age, prior stroke/TIA and SEC as independent risk factors for DRT. After PSM, implantation depth was found to be predictive. Rates of stroke/TIA were higher in DRT patients (13.5\% vs. 3.8\%, Hazard Ratio: 4.21 [95\%-confidence interval: 1.88-9.49], p < 0.01).CONCLUSIONS: DRT after LAAC is associated with adverse outcome and appears to be of multifactorial origin, depending on patient characteristics, anticoagulation regimen and device position.",

keywords = "Anticoagulants/therapeutic use, Atrial Appendage/diagnostic imaging, Atrial Fibrillation/complications, Echocardiography, Humans, Ischemic Attack, Transient, Registries, Risk Factors, Stroke/diagnosis, Thrombosis/diagnosis, Treatment Outcome, Stroke, Atrial fibrillation, Left atrial appendage closure, Device-related thrombus",

author = "Vivian Vij and Kerstin Piayda and Dominik Nelles and Steffen Gloekler and Roberto Galea and Monika F{\"u}rholz and Bernhard Meier and Marco Valgimigli and Gilles O'Hara and Dabit Arzamendi and Victor Agudelo and Lluis Asmarats and Xavier Freixa and Eduardo Flores-Umanzor and \{De Backer\}, Ole and Lars S{\o}ndergaard and Luis Nombela-Franco and Angela McInerney and Kasper Korsholm and Nielsen-Kudsk, \{Jens Erik\} and Shazia Afzal and Tobias Zeus and Felix Operhalski and Boris Schmidt and Gilles Montalescot and Paul Guedeney and Xavier Iriart and Noelie Miton and Jacqueline Saw and Thomas Gilhofer and Laurent Fauchier and Egzon Veliqi and Felix Meincke and Nils Petri and Peter Nordbeck and Dmitrii Ognerubov and Evgeny Merkulov and Ignacio Cruz-Gonz{\'a}lez and Rocio Gonzalez-Ferreiro and Bhatt, \{Deepak L\} and Alessandra Laricchia and Antonio Mangieri and Heyder Omran and Schrickel, \{Jan Wilko\} and Josep Rodes-Cabau and Horst Sievert and Georg Nickenig and Alexander Sedaghat",

note = "{\textcopyright} 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.",

year = "2022",

month = nov,

doi = "10.1007/s00392-022-02065-4",

language = "English",

volume = "111",

pages = "1276--1285",

journal = "Clinical research in cardiology : official journal of the German Cardiac Society",

issn = "1861-0684",

publisher = "Springer Science and Business Media Deutschland GmbH",

number = "11",

}

TY - JOUR

T1 - Clinical and echocardiographic risk factors for device-related thrombus after left atrial appendage closure

T2 - an analysis from the multicenter EUROC-DRT registry

AU - Vij, Vivian

AU - Piayda, Kerstin

AU - Nelles, Dominik

AU - Gloekler, Steffen

AU - Galea, Roberto

AU - Fürholz, Monika

AU - Meier, Bernhard

AU - Valgimigli, Marco

AU - O'Hara, Gilles

AU - Arzamendi, Dabit

AU - Agudelo, Victor

AU - Asmarats, Lluis

AU - Freixa, Xavier

AU - Flores-Umanzor, Eduardo

AU - De Backer, Ole

AU - Søndergaard, Lars

AU - Nombela-Franco, Luis

AU - McInerney, Angela

AU - Korsholm, Kasper

AU - Nielsen-Kudsk, Jens Erik

AU - Afzal, Shazia

AU - Zeus, Tobias

AU - Operhalski, Felix

AU - Schmidt, Boris

AU - Montalescot, Gilles

AU - Guedeney, Paul

AU - Iriart, Xavier

AU - Miton, Noelie

AU - Saw, Jacqueline

AU - Gilhofer, Thomas

AU - Fauchier, Laurent

AU - Veliqi, Egzon

AU - Meincke, Felix

AU - Petri, Nils

AU - Nordbeck, Peter

AU - Ognerubov, Dmitrii

AU - Merkulov, Evgeny

AU - Cruz-González, Ignacio

AU - Gonzalez-Ferreiro, Rocio

AU - Bhatt, Deepak L

AU - Laricchia, Alessandra

AU - Mangieri, Antonio

AU - Omran, Heyder

AU - Schrickel, Jan Wilko

AU - Rodes-Cabau, Josep

AU - Sievert, Horst

AU - Nickenig, Georg

AU - Sedaghat, Alexander

PY - 2022/11

Y1 - 2022/11

N2 - BACKGROUND: Data on Device-related Thrombus (DRT) after left atrial appendage closure (LAAC) remain scarce. This study aimed to investigate risk factors for DRT from centers reporting to the EUROC-DRT registry.METHODS: We included 537 patients (112 with DRT and 425 without DRT) who had undergone LAAC between 12/2008 and 04/2019. Baseline and implantation characteristics, anti-thrombotic treatment and clinical outcomes were compared between both groups in uni- and multivariate analyses. Additional propensity-score matching (PSM) was conducted to focus on the role of implantation characteristics.RESULTS: Patients with DRT showed higher rates of previous stroke/transient ischemic attack (TIA) (49.1% vs. 34.7%, p < 0.01), spontaneous echocardiographic contrast (SEC) (44.9% vs. 27.7%, p < 0.01) and lower left atrial appendage (LAA) peak emptying velocity (35.4 ± 18.5 vs. 42.4 ± 18.0 cm/s, p = 0.02). Occluders implanted in DRT patients were larger (25.5 ± 3.8 vs. 24.6 ± 3.5 mm, p = 0.03) and implanted deeper in the LAA (mean depth: 7.6 ± 4.7 vs. 5.7 ± 4.7 mm, p < 0.01). Coverage of the appendage ostium was achieved less often in DRT patients (69.5% vs. 81.5%, p < 0.01), while DRT patients were less frequently on oral anticoagulation (7.1% vs. 16.7%, p < 0.01). Multivariate analysis identified age, prior stroke/TIA and SEC as independent risk factors for DRT. After PSM, implantation depth was found to be predictive. Rates of stroke/TIA were higher in DRT patients (13.5% vs. 3.8%, Hazard Ratio: 4.21 [95%-confidence interval: 1.88-9.49], p < 0.01).CONCLUSIONS: DRT after LAAC is associated with adverse outcome and appears to be of multifactorial origin, depending on patient characteristics, anticoagulation regimen and device position.

AB - BACKGROUND: Data on Device-related Thrombus (DRT) after left atrial appendage closure (LAAC) remain scarce. This study aimed to investigate risk factors for DRT from centers reporting to the EUROC-DRT registry.METHODS: We included 537 patients (112 with DRT and 425 without DRT) who had undergone LAAC between 12/2008 and 04/2019. Baseline and implantation characteristics, anti-thrombotic treatment and clinical outcomes were compared between both groups in uni- and multivariate analyses. Additional propensity-score matching (PSM) was conducted to focus on the role of implantation characteristics.RESULTS: Patients with DRT showed higher rates of previous stroke/transient ischemic attack (TIA) (49.1% vs. 34.7%, p < 0.01), spontaneous echocardiographic contrast (SEC) (44.9% vs. 27.7%, p < 0.01) and lower left atrial appendage (LAA) peak emptying velocity (35.4 ± 18.5 vs. 42.4 ± 18.0 cm/s, p = 0.02). Occluders implanted in DRT patients were larger (25.5 ± 3.8 vs. 24.6 ± 3.5 mm, p = 0.03) and implanted deeper in the LAA (mean depth: 7.6 ± 4.7 vs. 5.7 ± 4.7 mm, p < 0.01). Coverage of the appendage ostium was achieved less often in DRT patients (69.5% vs. 81.5%, p < 0.01), while DRT patients were less frequently on oral anticoagulation (7.1% vs. 16.7%, p < 0.01). Multivariate analysis identified age, prior stroke/TIA and SEC as independent risk factors for DRT. After PSM, implantation depth was found to be predictive. Rates of stroke/TIA were higher in DRT patients (13.5% vs. 3.8%, Hazard Ratio: 4.21 [95%-confidence interval: 1.88-9.49], p < 0.01).CONCLUSIONS: DRT after LAAC is associated with adverse outcome and appears to be of multifactorial origin, depending on patient characteristics, anticoagulation regimen and device position.

KW - Anticoagulants/therapeutic use

KW - Atrial Appendage/diagnostic imaging

KW - Atrial Fibrillation/complications

KW - Echocardiography

KW - Humans

KW - Ischemic Attack, Transient

KW - Registries

KW - Risk Factors

KW - Stroke/diagnosis

KW - Thrombosis/diagnosis

KW - Treatment Outcome

KW - Stroke

KW - Atrial fibrillation

KW - Left atrial appendage closure

KW - Device-related thrombus

UR - https://www.scopus.com/pages/publications/85134489269

U2 - 10.1007/s00392-022-02065-4

DO - 10.1007/s00392-022-02065-4

M3 - Journal article

C2 - 35849156

SN - 1861-0684

VL - 111

SP - 1276

EP - 1285

JO - Clinical research in cardiology : official journal of the German Cardiac Society

JF - Clinical research in cardiology : official journal of the German Cardiac Society

IS - 11

ER -

Clinical and echocardiographic risk factors for device-related thrombus after left atrial appendage closure: an analysis from the multicenter EUROC-DRT registry

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