title: Left atrial thrombus and prognosis after anticoagulation therapy in patients with atrial fibrillation.
abstract: BACKGROUND
  Anticoagulation therapy reduces the risk of thromboembolic events by two-thirds in patients with atrial fibrillation (AF). The prevalence of left atrial thrombus (LAT) in AF patients with anticoagulation therapy has not been fully investigated.
  
  
  OBJECTIVE
  To investigate the prevalence of LAT and its impact on the outcomes in patients with nonvalvular AF after anticoagulation therapy.
  
  
  METHODS
  This study consisted of 231 patients with nonvalvular AF who had transthoracic (TTE) and transesophageal echocardiographic (TEE) examinations more than 3 weeks after anticoagulation therapy. The clinical and echocardiographic characteristics were evaluated.
  
  
  RESULTS
  LAT was observed in 13 (8.8%) of 148 patients with sub-therapeutic anticoagulation, and in 3 (3.6%) of 83 patients with sufficient anticoagulation. The presence of LAT was associated with higher CHADS(2) score, decreased LA volume changes and the presence of spontaneous echocardiographic contrast (SEC) in patients with sub-therapeutic anticoagulation. Patients with LAT after sufficient anticoagulation were male with permanent AF who had decreased left ventricular systolic and diastolic function and dilated LA on TTE and SEC, and reduced appendage flow velocity on TEE. Patients with LAT had worse cardiovascular outcomes compared with those without LAT (p=0.02).
  
  
  CONCLUSIONS
  We demonstrated that LAT was a univariate risk factor associated with worse cardiovascular outcomes, which was observed in 8.8% of patients with sub-therapeutic anticoagulation and 3.6% of patients with sufficient anticoagulation.
authors.affiliation: Department of Medicine, Cardiovascular Division, Osaka Ekisaikai Hospital, 2-1-10 Honden, Nishi-ku, Osaka 550-0022, Japan.
authors.forename: Shota
authors.initials: S
authors.lastname: Fukuda
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Watanabe
authors.forename: Kenei
authors.initials: K
authors.lastname: Shimada
authors.forename: Masaru
authors.initials: M
authors.lastname: Aikawa
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Kono
authors.forename: Satoshi
authors.initials: S
authors.lastname: Jissho
authors.forename: Haruyuki
authors.initials: H
authors.lastname: Taguchi
authors.forename: Jun
authors.initials: J
authors.lastname: Umemura
authors.forename: Minoru
authors.initials: M
authors.lastname: Yoshiyama
authors.forename: Takahiro
authors.initials: T
authors.lastname: Shiota
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Sumiyoshi
authors.forename: Junichi
authors.initials: J
authors.lastname: Yoshikawa
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D017548:Echocardiography, Transesophageal; D005260:Female; D006325:Heart Atria; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants