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

Matthias Linder, Lisa Voigtländer, Yvonne Schneeberger, Oliver Daniel Bhadra, David Grundmann, Till Demal, Alina Goßling, Sebastian Ludwig, Andreas Schaefer, Lara Waldschmidt, Johannes Schirmer, Hermann Reichenspurner, Stefan Blankenberg, Ulrich Schäfer, Dirk Westermann, Niklas Schofer, Lenard Conradi, Moritz Seiffert

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. 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 was4.4% 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). 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.