YẾU TỐ NGUY CƠ HUYẾT KHỐI TIỂU NHĨ TRÁI Ở BỆNH NHÂN RUNG NHĨ TẠI BỆNH VIỆN TIM TÂM ĐỨC

Abstract

Introduction: Atrial fibrillation is the most common cardiac arrhythmia in clinical practice and is closely associated with an increased risk of ischemic stroke and systemic embolism. More than 90% of intra-atrial thrombi in patients with AF originate from the left atrial appendage. Identifying risk factors for left atrial appendage thrombus formation is crucial for guiding early transesophageal echocardiography evaluation, optimizing anticoagulation therapy, and determining appropriate interventional strategies. This study aimed to identify factors associated with LAAT formation in patients with AF. Methods: A cross-sectional study was conducted at Tam Duc Heart Hospital from December 2024 to September 2025, including 117 adult patients (≥ 18 years) diagnosed with AF who underwent TEE for LAA thrombus assessment. Data collected included clinical characteristics, comorbidities, CHA₂DS₂-VASc score, laboratory parameters (CRP, uric acid, NT-proBNP, eGFR), and echocardiographic indices (left atrial diameter, left ventricular ejection fraction). Statistical analyses were performed using SPSS version 20.0, with p < 0.05 considered statistically significant. Results: Among 117 patients, 14 (12.0%) had LAAT detected. Compared with those without LAAT, patients with LAAT had a significantly higher prevalence of congestive heart failure (35,7% vs. 1,9%; p < 0,001) and non-paroxysmal AF (persistent/permanent type) (85.7% vs. 30,1%; p < 0.001). Higher CHA₂DS₂-VASc score, uric acid, NT-proBNP levels, and left atrial diameter were observed in the LAAT group (p = 0.011, 0.008, 0.008, and 0.001, respectively). However, multivariable logistic regression identified congestive heart failure as the strongest independent predictor of LAAT (OR = 13,33; 95% CI: 1,235 – 143,912; p = 0,033). In addition, non-paroxysmal AF was also found to be a strong prognostic factor, conferring a nearly tenfold higher risk of LAAT compared with paroxysmal AF (OR = 9,95; 95% CI: 1,586 – 62,372; p = 0,014). Conclusion: Congestive heart failure and non-paroxysmal AF are independent risk factors for LAAT formation. Integrating clinical assessment with echocardiographic evaluation may facilitate early detection, better risk stratification, and timely intervention in AF patients