BACKGROUND Peak left atrial longitudinal strain (PALS) can help identify left atrial appendage thrombus (LAAT) in patients with atrial fibrillation. Nevertheless, few studies have been performed in patients in sinus rhythm without established indications for anticoagulation but with increased risk of LAAT, such as heart failure (HF) with severe left ventricular systolic dysfunction patients. The primary aim of this study was to identify clinical and transthoracic echocardiography predictors of LAAT in HF patients with very low left ventricular ejection fraction and sinus rhythm. The secondary objective was to analyze frequencies and predictors of a composite clinical endpoint of death or hospitalization for ischemic stroke. METHODS We included 63 patients with HF, left ventricular ejection fraction < 25%, sinus rhythm at presentation, no history of atrial fibrillation, and without any established indications for anticoagulation. We determined whether clinical and transthoracic echocardiography parameters, including left atrial strain analysis, predicted LAAT. Transesophageal echocardiography was performed in all patients. When LAAT was detected, anticoagulation was recommended. The participants were followed for a median of 28.6 months (range 4-40) to determine the composite endpoint. RESULTS LAAT was found in 20 (31.7%) patients. Global PALS was the best independent predictor of LAAT in univariate and multivariate logistic regression analyses (Gini coefficient 0.65, area under the receiver-operating characteristic curve 0.83). A global PALS value below 8% was a good discriminator of LAAT presence (odds ratio 30.4, 95% CI 7.2-128, p <  0.001). During follow-up, 18 subjects (28.6%) reached the composite clinical endpoint. CHA2DS2-VASc score, use of angiotensin-converting-enzyme inhibitors or angiotensin receptor blockers, and body surface area were significant predictors for the composite endpoint of death or hospitalization for ischemic stroke in the multivariate regression model. CONCLUSIONS LAAT was relatively common in our group of HF patients and PALS has shown prognostic potential in LAAT identification. Further research is needed to determine whether initiation of anticoagulation or additional screening supported by PALS measurements will improve clinical outcomes in these patients.

中文翻译：

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经胸超声心动图评估的总体左心房纵向峰值是患有心力衰竭且射血分数极低的窦性心律患者左心耳血栓的良好预测指标。

背景技术峰值左心房纵向应变（PALS）可帮助识别患有房颤的患者的左心耳血栓（LAAT）。然而，在没有确定抗凝指征但存在LAAT风险增加的窦性心律患者中，很少进行研究，例如患有严重左室收缩功能障碍的心力衰竭（HF）。这项研究的主要目的是确定左心室射血分数和窦性心律非常低的HF患者的LAAT的临床和经胸超声心动图预测指标。第二个目的是分析缺血性卒中死亡或住院的复合临床终点的频率和预测因素。方法我们纳入了63例HF，左心室射血分数<25％，出现窦性心律的患者，没有房颤史，也没有任何确定的抗凝适应症。我们确定临床和经胸超声心动图参数，包括左心房应变分析，是否可预测LAAT。所有患者均行经食道超声心动图检查。当检测到LAAT时，建议抗凝。随访参与者的中位数为28.6个月（范围为4-40），以确定复合终点。结果在20名患者中发现了LAAT（31.7％）。在单因素和多因素logistic回归分析中，全局PALS是LAAT的最佳独立预测指标（基尼系数0.65，接受者操作特征曲线下的面积0.83）。低于8％的全球PALS值可以很好地识别LAAT的存在（赔率30.4，95％CI 7.2-128，p <0.001）。在跟进过程中，18名受试者（28.6％）达到了综合临床终点。CHA2DS2-VASc评分，使用血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂以及体表面积是多因素回归模型中缺血性卒中死亡或住院复合终点的重要预测指标。结论LAAT在我们的HF患者组中相对常见，PALS已显示出LAAT鉴定的预后潜力。需要进一步的研究来确定抗凝治疗的开始或由PALS测量支持的其他筛查是否会改善这些患者的临床结局。多元回归模型中，血浆和体表面积是缺血性卒中死亡或住院综合终点的重要预测指标。结论LAAT在我们的HF患者组中相对常见，PALS已显示出LAAT鉴定的预后潜力。需要进一步的研究来确定抗凝治疗的开始或由PALS测量支持的其他筛查是否会改善这些患者的临床结局。多元回归模型中，血浆和体表面积是缺血性卒中死亡或住院综合终点的重要预测指标。结论LAAT在我们的HF患者组中相对常见，PALS已显示出LAAT鉴定的预后潜力。需要进一步的研究来确定抗凝治疗的开始或由PALS测量支持的其他筛查是否会改善这些患者的临床结局。