Background .– Transesophageal echocardiography (TEE) can detect left atrial (LA) thrombus and LA spontaneous echocardiographic contrast (SEC), which have been associated with a higher risk of thromboembolism in patients with atrial fibrillation (AF). We hypothesized that TEE-detected LASEC could predict cardiovascular events in AF in addition to clinical risk stratification in CHADS2 score = 0 patients.

Methods .– Among 763 consecutive patients hospitalized for non valvular AF (NVAF), prior to cardioversion, TEE was systematically performed within 24 h after admission; 205 patients had a CHADS2 score = 0. All patients were followed-up (mean 6.3 ± 4.3 years) and cardiovascular (CV) events (stroke, death, or heart failure) defining a composite endpoint were recorded.

Results .– Mean age was 54.5 ± 13.5 years. NVAF was paroxysmal in 101patients (49.3%), persistent in 82 (40.0%) and permanent in 22 (10.7%). LA thrombus was found in one patient (0.5%), LASEC in 60 (29.3%), classified as mild in 43 (21.0%), moderate in 14 (6.8%) and severe in three (1.5%). One hundred seventy six (87.1%) were prescribed warfarin and 25 (12.4%) aspirin at hospital discharge. At follow-up, death occurred in 27 patients (13.2%), stroke in five (2.4%), heart failure in four (2.0%). AF recurrence was observed in 60 patients (29.3%) and haemorrhage requiring hospitalization in five (2.4%). The Kaplan-Meier (figure) curves showed that the presence of LASEC (Yes/No) was associated with a higher risk of CV events.

Conclusions .– TEE-detected LASEC is associated with a higher risk of CV events (stroke, death, or heart failure) at long-term follow-up in NVAF at very low risk of thromboembolism.