Retrospective Study of 1255 Non-Anticoagulated Patients with Nonvalvular Atrial Fibrillation to Determine the Risk of Ischemic Stroke Associated with Left Atrial Spontaneous Echo Contrast on Transesophageal Echocardiography

BACKGROUND: Left atrial spontaneous echo contrast (LASEC) is associated with an increased risk of stroke in patients with nonvalvular atrial fibrillation (NVAF). Therefore, a tool that identifies the risk of LASEC in non-anticoagulated patients with NVAF may be helpful for stroke risk stratification and early stroke prevention in these patients. The aim of this retrospective study was to establish a novel risk score model to determine the risk of ischemic stroke associated with LASEC on transesophageal echocardiography (TEE). MATERIAL/METHODS: This study retrospectively and consecutively enrolled 1255 non-anticoagulated patients with NVAF who underwent TEE prior to catheter ablation or left atrial appendage occlusion. Most importantly, a novel nomogram was developed using a logistic regression model to predict the risk of LASEC. RESULTS: A nomogram was established for LASEC prediction which included 5 independent risk factors determined by multivariable logistic regression analysis: increased age, non-paroxysmal atrial fibrillation, previous stroke/transient ischemic attack, congestive heart failure, and left atrial enlargement. The receiver operating characteristic curve analysis showed that the area under the curve (AUC) of the novel risk score model was 0.879 (95% confidence interval: 0.849–0.909, P<0.001). Compared with the CHA2DS2-VASc score, the novel risk score model had a better predictive power (AUC: 0.879 vs 0.617, P<0.001). CONCLUSIONS: This novel risk score model effectively predicted the presence of LASEC in non-anticoagulated patients with NVAF.