Association of CHADS₂and CHA₂DS₂-VASc Scores with Left Atrial Thrombus with Nonvalvular Atrial Fibrillation: A Single Center Based Retrospective Study in a Cohort of 2695 Chinese Subjects

Abstract

The main mechanism of the CHADS2 and CHA2DS2-VASc scores to predict stroke in nonvalvular atrial fibrillation (NVAF) is still controversial. We evaluated the association of the CHADS2 and CHA2DS2-VASc scores with left atrial thrombus (LAT) as detected by transesophageal echocardiographic (TEE) and compared the predictive ability of these risk stratification schemes with nonvalvular atrial fibrillation (NVAF). Data from 2,695 consecutive NVAF patients in whom TEE was performed for screening LAT from July 2007 to February 2014 were analyzed. Only 3% of the subjects had LAT. Presence of LAT was not significantly associated with either CHADS2 (P = 0.07) or CHA2DS2-VASc score (P = 0.12). The area under the curve (AUC) concerning LAT prediction using CHADS2 and CHA2DS2-VASc was 0.574 and 0.569, respectively. A composition model includes previous stroke or transient ischemic attack, nonparoxysmal AF, moderate to severe left ventricular systolic dysfunction, left atrial enlargement, and cardiomyopathy which improved the discrimination significantly (AUC = 0.743). In our cohort, both CHADS2 and CHA2DS2-VASc scores were of limited value for predicting LAT in patients with NVAF. This questions the CHADS2/CHA2DS2-VASc score predicting stroke mainly through the mechanism of cardiogenic embolism. A scoring scheme combining clinical and echocardiographic parameters may better predict LAT as a surrogate for cardioembolic risk in NVAF patients.

Incidence of intracardiac thrombus formation prior to electrical cardioversion in respect to the mode of oral anticoagulation

“…Consistently reported independent clinical risk factors from retrospective and prospective data include impairment of heart function (heart failure, cardiomyopathy), history of prior stroke or TIA, and diabetes, which are also represented in commonly used risk score among others . Further, echocardiographic parameters such as LAA‐velocity, left atrial enlargement, and presence of SEC were predictors for thrombus formation.…”

Left Atrial Strain as Evaluated by Two-Dimensional Speckle Tracking Predicts Left Atrial Appendage Dysfunction in Chinese Patients with Atrial Fibrillation

“…is inconsistency was also observed in previous studies [23,24]. It is clear that the scoring system includes an assessment of the risks of early stroke, including those that cause vascular wall injury and hypercoagulable status [25,26]. However, the scoring system did not analyze the effect of AF itself on cardiac remodeling which is a continuous present risk factor for stroke.…”

Atrial fibrillation and CHA2DS2VASc score of 1 - is there a problem in clinical practice?

“…В нашем исследовании анализ пиковой скорости кровотока в ушке ЛП не проводился, однако ранее установлено, что снижение скорости этого кровотока (<20 см/сек) -ФР инсульта [15]. Замедление кровотока способствует формированию тромба в ушке ЛП, а пациенты с тромбом в ЛП или в его ушке имеют очень высокий риск церебральных эмболических осложнений (до 16% в год) [16]. Вместе с тем, 50% пациентов с тромбом в ЛП или в его ушке имеют низкое число баллов по шкале CHA 2 DS 2 VASc и риск кардиоэмболических осложнений у таких больных может быть недооценен [16].…”