Transthoracic signs of left atrial cardiomyopathy predict presence of left atrial thromboembolic substrate

Retrospective analysis of n=645 patients with same-session TTE and TOE, all performed by the same senior observer Comprehensive reevaluation of LA function and LAA findings in TTE and TOE LA cardiomyopathy assessed by means of LAS, LAVImax, LAVImin and LAEF Left atrial thromboembolic substrate (LATS) was defined as spontaneous echo contrast (SEC) grade 2+, sludge, or thrombus Low-risk cohort per guidelines (n = 323) TOE typically not recommended before rhythm control 18.3% had LATS In AF/AFL subgroup (n = 157): -34.4% had LATS -8.3% had sludge or thrombus Key Finding: Left atrial strain (LAS) is the strongest independent predictor of LATS: Each 1% increase in LAS 18% lower odds of LATS (OR 0.819, p < 0.001) Traditional risk factors were not statistically significant after LAS was included Conclusion: Current clinical risk scores alone may miss patients at risk for thromboembolism.Assessing left atrial cardiomyopathy by TTE adds important value and can guide the need for TOE before elective rhythm control interventions.Low-risk patient, but LA cardiomyopathy detected on TTE?Consider TOE before rhythm intervention Adding left atrial strain (LAS) significantly improves LATS prediction compared to clinical parameters alone (heart rhythm, CHA2DS2-VA score, prior stroke, anticoagulation status):