ArticleQuantitative imaging in medicine and surgery2026
Nomogram for predicting left atrial appendage dense spontaneous echo contrast and/or thrombosis (dense spontaneous echo contrast/left atrial appendage thrombus): a comparison with CHADS
Article in Quantitative imaging in medicine and surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Non-valvular atrial fibrillation (NVAF) carries a high risk of left atrial appendage thrombus (LAAT) and dense spontaneous echo contrast (dense SEC), the primary triggers of cardioembolic stroke. Conventional CHADS Methods: We retrospectively enrolled 159 NVAF patients who underwent 3D-TEE from July 2024 to December 2025, stratified into a dense SEC/LAAT positive group (n=50) and a negative group (n=109). Variables with severe multicollinearity [variance inflation factor (VIF) ≥10] were excluded. Univariate logistic regression (P<0.10) screened candidate predictors, followed by forward stepwise multivariate logistic regression to identify independent risk factors and construct a nomogram. Model discrimination, calibration and clinical utility were assessed via receiver operating characteristic (ROC) curves, calibration curves, 10-fold cross-validation, decision curve analysis (DCA) and clinical impact curves; inter-model area under the curve (AUC) comparisons used P<0.05 as the statistical significance threshold. Results: Four independent predictors of dense SEC/LAAT were identified: D-dimer >0.550 mg/L [odds ratio (OR) =7.805, 95% confidence interval (CI): 2.044-29.795, P=0.002]; European Heart Rhythm Association (EHRA) score ≥ IIb (OR =6.255, 95% CI: 1.458-26.833, P=0.013); LAA poor echogenicity (OR =23.037, 95% CI: 5.651-93.909, P<0.001); LAA orifice morphology (OR =0.537, 95% CI: 0.296-0.975, P=0.041). The nomogram achieved an original AUC of 0.892 (95% CI: 0.839-0.945) at an optimal cutoff value of 0.29, with sensitivity 0.82, specificity 0.83, accuracy 0.82, and negative predictive value 0.91. It significantly outperformed CHADS Conclusions: The 3D-TEE-based nomogram shows acceptable discrimination for dense SEC/LAAT in NVAF patients and addresses the limitations of traditional risk scoring systems. Nevertheless, prominent overfitting prevents its direct clinical use without external validation and recalibration; it can serve as an auxiliary research tool for LAAT risk stratification.
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