BACKGROUND: Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) can be used to detect the presence of left atrial thrombus and left atrial spontaneous echocardiographic contrast (LASEC).
OBJECTIVES: We sought to evaluate the prognostic value of TTE and TEE in predicting stroke and all-cause death at 5-year follow-up in patients with non-valvular atrial fibrillation (NVAF).
METHODS: This study included patients hospitalized with electrocardiography-diagnosed NVAF in Saint Antoine University Hospital, Paris, between July 1998 and December 2011 who underwent TTE and TEE evaluation within 24 hours of admission. Cox proportionalhazards models were used to identify predictors of the composite outcome (stroke or all cause death). RESULTS: During 5 years of follow-up, stroke/death occurred in 185/903 patients (20.5%). By multivariable analysis, independent predictors of stroke/death were CHA2DS2-VASc score (hazard ratio [HR]: 1.35; 95% confidence interval [CI]: 1.25-1.47; p <0.001), left atrial area >20 cm2 (HR: 1.59; 95% CI: 1.08-2.35; p =0.018) moderate LASEC (HR: 1.72; 95% CI: 1.13-2.62; p =0.012) and severe LASEC (HR: 2.04; 95% CI: 1.16-3.58; p =0.013). Independent protective predictors were dyslipidemia (HR: 0.60; 95% CI: 0.43-0.83; p =0.002) and discharge prescription of antiarrhythmics (HR: 0.59; 95% CI: 0.40-0.87; p =0.008). Adding LASEC to the CHA2DS2-VASc score modestly improved predictive accuracy and risk classification, with a C index of 0.71 vs. 0.69 (p = 0.004). CONCLUSIONS: Presence of moderate/severe LASEC is a strong and independent predictor of stroke/death at 5-year follow-up in patients with NVAF. The inclusion of LASEC in stroke risk scores could improve risk stratification.