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Introduction: The left atrium appendage thrombus (LAAT) formation is a complex process. A CHA 2 DS 2 -VASc scale is an established tool for determining the thromboembolic risk and initiation of anticoagulation treatment in patients with atrial fibrillation or flutter (AF/AFL). We aimed to identify whether any transthoracic echocardiography (TTE) parameters could have an additional impact on LAAT detection., Methods: That is a sub-study of multicenter, prospective, observational study LATTEE (NCT03591627), which enrolled 3,109 consecutive patients with AF/AFL referred for transesophageal echocardiography (TEE) before cardioversion or ablation., Results: LAAT was diagnosed in 8.0% of patients. The univariate logistic regression analysis [based on pre-specified in the receiver operating characteristic (ROC) analysis cut-off values with AUC ≥ 0.7] identified left ventricular ejection fraction (LVEF) ≤ 48% and novel TTE parameters i.e., the ratios of LVEF and left atrial diameter (LAD) ≤ 1.1 (AUC 0.75; OR 5.64; 95% CI 4.03-7.9; p < 0.001), LVEF to left atrial area (LAA) ≤ 1.7 (AUC 0.75; OR 5.64; 95% CI 4.02-7.9; p < 0.001), and LVEF to indexed left atrial volume (LAVI) ≤ 1.1 (AUC 0.75, OR 6.77; 95% CI 4.25-10.8; p < 0.001) as significant predictors of LAAT. In a multivariate logistic regression analysis, LVEF/LAVI and LVEF/LAA maintained statistical significance. Calculating the accuracy of the abovementioned ratios according to the CHA 2 DS 2 -VASc scale values revealed their highest predictive power for LAAT in a setting with low thromboembolic risk., Conclusion: Novel TTE indices could help identify patients with increased probability of the LAAT, with particular applicability for patients at low thromboembolic risk., Competing Interests: Authors AK-C, BW-K, and MRK received honoraria for lectures from Bayer, Boehringer Ingelheim, and Pfizer, outside the submitted work. Author LD-S received speaker fees from Bayer, Boehringer Ingelheim, and Pfizer–outside the submitted work. Author KM-S received speaker fees from Bayer, Pfizer, Boehringer Ingelheim, AstraZeneca, Novartis, and Servier–outside the submitted work. Author AT-K received speaker fees from Boehringer-Ingelheim–outside the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Kaufmann, Wabich, Kapłon-Cieślicka, Gawałko, Budnik, Uziębło-Życzkowska, Krzesiński, Starzyk, Wożakowska-Kapłon, Wójcik, Błaszczyk, Hiczkiewicz, Budzianowski, Mizia-Stec, Wybraniec, Kosmalska, Fijałkowski, Szymańska, Dłużniewski, Haberka, Kucio, Michalski, Kupczyńska, Tomaszuk-Kazberuk, Wilk-Śledziewska, Wachnicka-Truty, Koziński, Burchardt and Daniłowicz-Szymanowicz.)

Background: Our aim was to assess the characteristics and to identify predictors of left atrial thrombus (LAT) in patients under age 65 with atrial fibrillation (AF) or atrial flutter (AFl)., Methods: We conducted a subanalysis of a multicenter, prospective, observational study [the LATTEE registry]. Consecutive AF/AFl patients referred for cardioversion or ablation were enrolled., Results: Of the 3,109 patients included in the study, 1,276 were under age 65 (41%). Compared to non-LAT patients, those with LAT ( n = 76) had higher CHA 2 DS 2 -VASc score ( p < 0.001), more frequently had non-paroxysmal AF/AFl ( p < 0.001), heart failure ( p < 0.001), history of diabetes mellitus ( p = 0.001), transient ischemic attack ( p = 0.04), coronary artery disease ( p = 0.02), and chronic kidney disease ( p < 0.001). The LAT patients were also more often smokers ( p = 0.004) and were more frequently treated with vitamin K antagonists (VKAs) ( p < 0.001). Transthoracic echocardiography revealed a higher left atrial area ( p < 0.001), lower left ventricular ejection fraction (LVEF) ( p < 0.001), and lower value of LA appendage emptying volume in LAT than in non-LAT patients ( p < 0.001). LVEF (OR 2.95; 95% CI: 1.32-6.59, p = 0.008), non-paroxysmal AF/AFl (OR 7.1; 95% CI: 2.05-24.63, p = 0.002) and treatment with VKAs (OR 4.92; 95% CI: 2.48-9.75, p < 0.001) were identified as independent predictors of LAT in younger patients., Conclusions: Our study, which focused on younger patients with AF/AFl, indicated substantial clinical and echocardiographic differences between participants with and without LAT. In the AF/AFl patients younger than age 65, the independent predictors of LAT included non-paroxysmal AF/AFl, lower LVEF, and treatment with VKAs., Competing Interests: Author AK-C honoraria for lectures from Bayer, Boehringer Ingelheim, Pfizer, outside the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Uziȩbło-Życzkowska, Kapłon-Cieślicka, Gawałko, Budnik, Starzyk, Wożakowska-Kapłon, Daniłowicz-Szymanowicz, Kaufmann, Wójcik, Błaszczyk, Hiczkiewicz, Łojewska, Mizia-Stec, Wybraniec, Kosmalska, Fijałkowski, Szymańska, Gos, Haberka, Kucio, Michalski, Kupczyńska, Tomaszuk-Kazberuk, Wilk-Śledziewska, Wachnicka-Truty, Koziński, Burchardt and Krzesiński.)