{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:41:16Z","timestamp":1760146876715,"version":"build-2065373602"},"reference-count":35,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2024,12,18]],"date-time":"2024-12-18T00:00:00Z","timestamp":1734480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: The risks of blood clot formation, stroke, heart failure (HF), and cardiovascular death are enhanced in individuals with atrial flutter (AFL). However, it remains unclear whether left atrial appendage thrombus (LAAT) in individuals with AFL with anticoagulation enhances the risk of cardiovascular morbidity and mortality. Thus, in the current trial, we aimed to evaluate the predictive role of LAAT for cardiovascular outcomes in individuals with AFL who were receiving anticoagulation and admitted for electrical cardioversion. Methods: Ninety patients were included in this prospective observational cohort study. The primary endpoint was the identification of LAAT by transesophageal echocardiographic examination. All participants were observed for a median of 2114.5 (interquartile range, 1487.5\u20132591) days to identify the secondary endpoints: cardiovascular death, transient ischemic attack (TIA), stroke, systemic thromboembolic complications, hospitalization due to HF, or myocardial infarction. Results: LAAT was identified in nine (10%) patients. No differences in cardiovascular outcomes between patients with and without LAAT were documented. However, a higher CHA2DS2-VASc score, previous myocardial infarction, and previous stroke\/TIA\/systemic thromboembolism were associated with significantly higher rates of hospitalization due to HF. Decreased left ventricular ejection fraction (LVEF) was associated with significantly higher rates of cardiovascular death, underscoring the significance of this marker in disease prognosis. Conclusions: The impact of LAAT on cardiovascular outcomes was insignificant. Higher CHA2DS2-VASc scores, previous myocardial infarction, previous stroke\/TIA\/systemic thromboembolism, and lower LVEF significantly affected long-term prognosis and were associated with a poor prognosis.<\/jats:p>","DOI":"10.3390\/jcm13247724","type":"journal-article","created":{"date-parts":[[2024,12,18]],"date-time":"2024-12-18T09:43:03Z","timestamp":1734514983000},"page":"7724","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cardiovascular Outcomes in Patients with Atrial Flutter and Oral Anticoagulation: The Predictive Role of Left Atrial Appendage Thrombus in a Long-Term, Prospective, Observational Cohort Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0722-9719","authenticated-orcid":false,"given":"\u0141ukasz","family":"Turek","sequence":"first","affiliation":[{"name":"The Faculty of Medicine, Jan Kochanowski University, 25-369 Kielce, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0495-2952","authenticated-orcid":false,"given":"Marcin","family":"Sadowski","sequence":"additional","affiliation":[{"name":"The Faculty of Medicine, Jan Kochanowski University, 25-369 Kielce, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8530-434X","authenticated-orcid":false,"given":"Jacek","family":"Kurzawski","sequence":"additional","affiliation":[{"name":"The Faculty of Medicine, Jan Kochanowski University, 25-369 Kielce, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marianna","family":"Janion","sequence":"additional","affiliation":[{"name":"The Faculty of Medicine, Jan Kochanowski University, 25-369 Kielce, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"151","DOI":"10.5114\/ms.2021.107460","article-title":"Atrial fibrillation and atrial flutter\u2014The state of the art. Part 1","volume":"37","author":"Turek","year":"2021","journal-title":"Med. Stud."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2242","DOI":"10.1016\/S0735-1097(00)00982-7","article-title":"Incidence and predictors of atrial flutter in the general population","volume":"36","author":"Granada","year":"2000","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"euae195","DOI":"10.1093\/europace\/euae195","article-title":"Global burden of atrial fibrillation\/atrial flutter and its attributable risk factors from 1990 to 2021","volume":"26","author":"Cheng","year":"2024","journal-title":"Europace"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1161\/CIR.0000000000001193","article-title":"2023 ACC\/AHA\/ACCP\/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"149","author":"Joglar","year":"2024","journal-title":"Circulation"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"132","DOI":"10.5114\/ms.2022.117672","article-title":"Left atrial appendage thrombus in patients referred to electrical cardioversion for typical atrial flutter","volume":"38","author":"Turek","year":"2022","journal-title":"Med. Stud."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1016\/S0002-9149(00)01374-6","article-title":"Risk of stroke in patients with atrial flutter","volume":"87","author":"Biblo","year":"2001","journal-title":"Am. J. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1093\/eurheartj\/ehz467","article-title":"2019 ESC Guidelines for the management of patients with supraventricular tachycardiaThe Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC)","volume":"41","author":"Brugada","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1016\/j.cjca.2018.01.001","article-title":"Elevated incidence of atrial fibrillation and stroke in patients with atrial flutter-a population-based study","volume":"34","author":"Gula","year":"2018","journal-title":"Can. J. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"265","DOI":"10.7326\/0003-4819-140-4-200402170-00008","article-title":"The natural history of lone atrial flutter","volume":"140","author":"Halligan","year":"2004","journal-title":"Ann. Intern. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.hrthm.2015.07.031","article-title":"Atrial flutter: Clinical risk factors and adverse outcomes in the Framingham Heart Study","volume":"13","author":"Rahman","year":"2016","journal-title":"Heart Rhythm."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1446","DOI":"10.1136\/heartjnl-2015-307550","article-title":"Atrial flutter and thromboembolic risk: A systematic review","volume":"101","author":"Vadmann","year":"2015","journal-title":"Heart"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1093\/europace\/euv128","article-title":"Prevalence of auricular thrombosis before atrial flutter cardioversion: A 17-year transoesophageal echocardiographic study","volume":"18","author":"Cresti","year":"2016","journal-title":"Europace"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"442.e13","DOI":"10.1016\/j.amjmed.2017.10.041","article-title":"Atrial appendage thrombosis risk is lower for atrial flutter compared with atrial fibrillation","volume":"131","author":"Huang","year":"2018","journal-title":"Am. J. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1253\/jcj.62.15","article-title":"Impaired atrial contraction in patients with atrial flutter and gradual recovery after cardioversion","volume":"62","author":"Kobayashi","year":"1998","journal-title":"Jpn. Circ. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"56","DOI":"10.18565\/cardio.2015.3.56-60","article-title":"Detection of signs of thrombus formation in patients with typical atrial flutter","volume":"55","author":"Sychev","year":"2015","journal-title":"Kardiologiia"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1016\/j.amjcard.2003.11.042","article-title":"Prognostic differences between atrial fibrillation and atrial flutter","volume":"93","author":"Lelorier","year":"2004","journal-title":"Am. J. Cardiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1053\/euhj.2000.2427","article-title":"Thromboembolic risk in atrial flutter. The FLASIEC (FLutter Atriale Societa Italiana di Ecografia Cardiovascolare) multicentre study","volume":"22","author":"Corrado","year":"2001","journal-title":"Eur. Heart J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e006406","DOI":"10.1161\/JAHA.117.006406","article-title":"Different implications of heart failure, ischemic stroke, and mortality between nonvalvular atrial fibrillation and atrial flutter\u2014A view from a national cohort study","volume":"6","author":"Lin","year":"2017","journal-title":"J. Am. Heart Assoc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3314","DOI":"10.1093\/eurheartj\/ehae176","article-title":"2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"45","author":"Rienstra","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"European Heart Rhythm Association, European Association for Cardio-Thoracic Surgery, Camm, A.J., Kirchhof, P., Lip, G.Y., Schotten, U., Savelieva, I., Ernst, S., Van Gelder, I.C., and Al-Attar, N. (2010). Guidelines for the management of atrial fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur. Heart J., 31, 2369\u20132429.","DOI":"10.1093\/eurheartj\/ehq278"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2719","DOI":"10.1093\/eurheartj\/ehs253","article-title":"2012 focused update of the ESC Guidelines for the management of atrial fibrillation: An update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association","volume":"33","author":"Camm","year":"2012","journal-title":"Eur. Heart J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1093\/europace\/eut083","article-title":"European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation","volume":"15","author":"Heidbuchel","year":"2013","journal-title":"Europace"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1467","DOI":"10.1093\/europace\/euv309","article-title":"Updated European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation","volume":"17","author":"Heidbuchel","year":"2015","journal-title":"Europace"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"247","DOI":"10.7326\/0003-4819-145-4-200608150-00004","article-title":"Using Standardized Serum Creatinine Values in the Modification of Diet in Renal Disease Study Equation for Estimating Glomerular Filtration Rate","volume":"145","author":"Levey","year":"2006","journal-title":"Ann. Int. Med."},{"key":"ref_25","first-page":"1142","article-title":"In Poland Echokardiografia w praktyce klinicznej\u2013Standardy Sekcji Echokardiografii Polskiego Towarzystwa Kardiologicznego 2007","volume":"65","author":"Kasprzak","year":"2007","journal-title":"Kardiol. Pol. (Pol. Heart J.)"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.ijcard.2017.04.014","article-title":"Left atrial appendage thrombi relate to easily accessible clinical parameters in patients undergoing atrial fibrillation transcatheter ablation: A multicenter study","volume":"241","author":"Anselmino","year":"2017","journal-title":"Int. J. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1436","DOI":"10.1016\/S0735-1097(02)01785-0","article-title":"Embolic events in patients with atrial fibrillation and effective anticoagulation: Value of transesophageal echocardiography to guide direct-current cardioversion. Final results of the Ludwigshafen Observational Cardioversion Study","volume":"39","author":"Seidl","year":"2002","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.euje.2005.12.014","article-title":"Recommendations for chamber quantification","volume":"7","author":"Lang","year":"2006","journal-title":"Eur. J. Echocardiogr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1016\/S0002-9149(99)80058-7","article-title":"Prevalence of intra-atrial thrombus in patients with atrial flutter","volume":"76","author":"Bikkina","year":"1995","journal-title":"Am. J. Cardiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1016\/j.amjcard.2011.10.007","article-title":"Usefulness of transesophageal echocardiography to confirm clinical utility of CHA2DS2-VASc and CHADS2 scores in atrial flutter","volume":"109","author":"Parikh","year":"2012","journal-title":"Am. J. Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1161\/01.CIR.95.4.962","article-title":"Prevalence of thrombus, spontaneous echo contrast, and atrial stunning in patients undergoing cardioversion of atrial flutter. A prospective study using transesophageal echocardiography","volume":"95","author":"Irani","year":"1997","journal-title":"Circulation"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Kaplon-Cieslicka, A., Gawalko, M., Budnik, M., Uzi\u0119b\u0142o-\u017byczkowska, B., Krzesi\u0144ski, P., Starzyk, K., Gorczyca-G\u0142owacka, I., Dani\u0142owicz-Szymanowicz, L., Kaufmann, D., and W\u00f3jcik, M. (2022). Left atrial thrombus in atrial fibrillation\/flutter patients in relation to anticoagulation strategy: LATTEE Registry. J. Clin. Med., 11.","DOI":"10.3390\/jcm11102705"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.amjcard.2018.09.027","article-title":"Prevalence and resolution of left atrial thrombus in patients with nonvalvular atrial fibrillation and flutter with oral anticoagulation","volume":"123","author":"Niku","year":"2019","journal-title":"Am. J. Cardiol."},{"key":"ref_34","first-page":"574","article-title":"Clinical characteristics of patients with atrial fibrillation or atrial flutter hospitalized during the COVID-19 pandemic: A population analysis of nearly 5 million people","volume":"131","author":"Myrda","year":"2021","journal-title":"Pol. Arch. Intern. Med."},{"key":"ref_35","first-page":"16450","article-title":"The effectiveness of atrial fibrillation identification using noninvasive long-term electrocardiographic monitoring system (NOMED-AF TECH)","volume":"133","author":"Mitrega","year":"2023","journal-title":"Pol. Arch. Intern. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/24\/7724\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:54:33Z","timestamp":1760115273000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/24\/7724"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,18]]},"references-count":35,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["jcm13247724"],"URL":"https:\/\/doi.org\/10.3390\/jcm13247724","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2024,12,18]]}}}