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Machine-learning model for predicting left atrial thrombus in patients with paroxysmal atrial fibrillation

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Abstract

Objective

Left atrial thrombus (LAT) poses a significant risk for stroke and other thromboembolic complication in patients with atrial fibrillation (AF). This study aimed to evaluate the incidence and predictors of LAT in patients with paroxysmal AF, utilizing machine learning techniques based on data from the Chinese Atrial Fibrillation study.

Methods

A large-scale multi-center retrospective study was conducted involving patients diagnosed with non-valvular paroxysmal AF. LAT incidence was assessed, and potential risk factors were analyzed. Machine learning algorithms, including decision tree, random forest, AdaBoost, k-Nearest Neighbor, and logistic regression, were employed to develop a predictive model for LAT.

Results

Of the 49,515 patients with paroxysmal AF, 1,058 patients (2.1%, 95% CI 2.0%-2.3%) were identified with LAT. Sixty-one variables were initially included to train machine learning models, with the random forest algorithm demonstrating the best predictive performance (AUC 0.833, 95%CI 0.730–0.924). The final model, refined to include nine essential features, achieved an AUC of 0.787 (95%CI 0.670–0.883). Calibration analysis indicated no significant difference between predicted and observed values (p = 0.181). The median predicted probabilities of LAT across quintiles were 2.3%, 7.0%, 11.8%, 16.6%, and 21.5%.

Conclusion

This simplified prediction model effectively identifies the risk of LAT in patients with paroxysmal AF, providing a valuable tool for clinical decision-making. Further studies are needed to explore AF management and risk stratification in other AF subtypes.
Title
Machine-learning model for predicting left atrial thrombus in patients with paroxysmal atrial fibrillation
Authors
Wanli Xiong
Qiqi Cao
Lu Jia
Min Chen
Tao Liu
Qingyan Zhao
Yanhong Tang
Bo Yang
Li Li
Shaobo Shi
He Huang
Congxin Huang
China Atrial Fibrillation Center Project Team
Publication date
01-12-2025
Publisher
BioMed Central
Published in
BMC Cardiovascular Disorders / Issue 1/2025
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/s12872-025-04847-w
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Case-Based Insights teaser image/© Eva Künzel