Incidence and clinical predictors of left atrial appendage thrombosis risk markers in end stage renal disease patients on maintenance haemodialysis

ABSTRACT

The incidence of intracardiac thrombosis and its risk markers in haemodialysis patients has not been sludied in the Egyptian population. This study was designed to determine the incidence of left atrial appendage [LAA] thrombosis and its risk markers as well as its clinical predictors in patients on maintenance haemodialysis in Suez Canal area in the period from 2003-2004. Transoesphageal echocardiography [TEE] was performed in 55 haemodialysis patients, 34 [62%] were males, the mean age was 46 +/- 10 years with mean dialysis duration b8 +/- b months. Any potential candidate with current or past chronic or intermittent atria] fibrillation or with cardiovascular diseases was excluded from the study. LAA abnormalities were defined as the presence of LAA thrombus, spontaneous echo contrast [SEC], LAA emplying or filling Doppler velocities <25cm/s, or LAA area 5 cm[2] Nothrombi were found in the LAA, but SEC detected in 4 [7%] patients, LAA velocities <25cm/s in 12 [22%] palients, and LAA area >5cm2 in 15 [27%] patients. On multe-variate analysis; older age, hypertension, diabetes mellitus, cigarette smoking, low haematocrit <30%, and left venlridilar mass index [LVM1] >116gm/m2 were the only ilinical variables independently associated with LAA abnormalities predisposing to thrombosis. Patients on maintenance haemodialysis in Suez Canal area are at low risk for LAA thrombosis. However, I.AA abnormalities predisposing to thrombosis can still be detected and correlated with older age, hypertension, diabetes incllilus, cigarette smoking, low haematocrit, and increased LVMI>116gin/m2.