Background.– Transesophageal echocardiography (TEE) can detect left atrial thrombus (LA) and dense LA spontaneous echocardiographic contrast (SEC) which have been associated with a higher risk of thromboembolism. Scarce data are available regarding their predicting value with regard to hard events including death. We hypothesized that TEE-detected LA thrombogenic milieu could predict cardiovascular events in AF in addition to clinical risk stratification.

Methods.– In 89 consecutive patients hospitalized for non valvular AF, TEE was systematically performed within 24H after admission. All patients were followed-up (mean 1.7 ± 0.6 years) and cardiovascular events (stroke, death, heart failure or acute coronary syndrome, ACS) were recorded.

Results.– Mean age was 67 ± 14 years. Fifty-four patients (61%) had hypertension, 22 (25%) had diabetes, 30 (34%) had prior history of AF, 33 (37%) had congestive heart failure and two (2%) had a history of stroke. LA thrombus was found in five patients (6%), LA dense SEC in 29 (33%), thus defining LA thrombogenic milieu in 29 patients (33%). Seventy-six patients (85%) were prescribed warfarin and 27 patients (27%) aspirin at discharge. At follow-up, death occurred in nine patients (10%), cardiovascular death in five (6%), stroke in two (2%), AF in 18 (20%), HF in 13 (15%) and ACS in one (1%). The Kaplan-Meier curves showed that the presence of LA thrombogenic milieu was associated with a higher risk of CV events (figure). In the multivariate analysis, only CHADS2 score (HR = 1.48, 95% CI = 1.01–2.18, P = 0.044) and presence of TEE-detected LA thrombogenic state (HR = 3.31, 95% CI = 1.14–9.59, P = 0.028) were predictors of cardiovascular events.

Conclusion.– TEE-detected LA thrombogenic milieu is associated with a higher risk of cardiovascular events, including death, stroke, HF and ACS.