The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Spontaneous echo contrast, left atrial appendage thrombus and stroke in patients undergoing transcatheter aortic valve implantation

DOI: 10.4244/EIJ-D-20-00743

1 University Heart and Vascular Center Hamburg, Department of Cardiology, Martinistraße 52, 20246 Hamburg, Germany

2 University Heart and Vascular Center Hamburg, Department of Cardiovascular Surgery, Martinistraße 52, 20246 Hamburg, Germany

3 Marienkrankenhaus, Department of Cardiology, Angiology and Intensive Care Medicine, Alfredstraße 9, 22087 Hamburg, Germany

4 German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Germany

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Aims: The relevance of spontaneous echo contrast (SEC) and left atrial appendage thrombus (LAAT) in patients undergoing transcatheter aortic valve implantation (TAVI) remains unclear. We assessed the prevalence of SEC and LAAT and evaluated the impact on periprocedural outcome after TAVI.

Methods and results: A total of 2,549 consecutive patients underwent TAVI between 2008 and 2017. After exclusion of cases with insufficient imaging, concomitant procedures or severe intraprocedural complications, 1,558 cases were analysed. Three groups were defined according to (pre)thrombotic formations: moderate or severe SEC (n=89), LAAT (n=53), and reference (n=1416). The primary outcome was disabling ischemic stroke within 24 hours. The prevalence was 4.4% for LAAT and 5.4% for moderate/severe SEC. The primary outcome occurred more frequently in patients with moderate/severe SEC (6.8%) compared to reference (2.1%) and LAAT (1.9%) groups (p=0.020). SEC was identified as an independent risk factor for the primary outcome (OR 3.54 [95%CI 1.30–9.61]; p=0.013). LAAT was associated with an impaired unadjusted 1-year survival (43.4%) compared to SEC (27.3%) and reference groups (18.7%; p<0.001).

Conclusion: SEC and LAAT were detected in a relevant number of patients undergoing TAVI. SEC may represent an important risk factor for intraprocedural stroke and increased mortality was observed in patients with LAAT.

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