CHA<sub>2</sub>DS<sub>2</sub>-VASc Score as a Predictor for Left Atrial Thrombus or Spontaneous Echo Contrast in Patients with Nonvalvular Atrial Fibrillation: A Meta-Analysis

Sun, Ping; Guo, Zhi; Zhang, Hong Bin

doi:10.1155/2020/2679539

Cited by 8 publications

(6 citation statements)

References 30 publications

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“…The CHA 2 DS 2 -VASc score has been reported to be predictive of SEC presence, 13 nevertheless, it was not a risk factor for SEC severity in our study. It is noteworthy that the CHA 2 DS 2 -VASc score system is applied to the general population, while our study focused on the subgroup of NVAF patients with SEC, and compared the characteristics of patients with different severity of SEC.…”

Section: Discussioncontrasting

confidence: 77%

“…11 Previous studies have identified several risk factors for SEC presence in NVAF patients, such as the medical history of heart failure (HF), presence of mitral regurgitation (MR), dilated LA, fibrinogen, and the CHA 2 DS 2 -VASc score. 6 12 13 14 However, it remains unclear if these risk factors could impact the severity of SEC and further affect the ischemic risk of NVAF. Moreover, there remain very limited data on the impact of different SEC densities on the ischemic stroke risk of NVAF patients after radiofrequency catheter ablation (RFCA).…”

Section: Introductionmentioning

confidence: 99%

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Severe Left Atrial Spontaneous Echo Contrast in Nonvalvular Atrial Fibrillation: Clinical Characteristics and Impact on Ischemic Risk Postablation

Wang

Chen

et al. 2022

Thromb Haemost

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Background Spontaneous echo contrast (SEC) is an important precursor for intracardiac thrombus and stroke. There is very limited data on characteristics of severe SEC and its impact on ischemic risk of NVAF patients after RFCA. Methods Transesophageal echocardiography files were reviewed between March 2009 and March 2021 in this monocentric retrospective study. SEC was classified into four levels. The primary endpoint was thromboembolic event (stroke, myocardial infarction, systemic embolism, and ensuing death), and the secondary endpoint included non-ischemic mortality and recurrent atrial arrhythmia. Results Six hundred SEC cases were enrolled and classified into mild SEC group (Grade 1-2, n=515) and severe SEC Group (Grade 3-4, n=85). Independent risk factors for severe SEC included higher brain natriuretic peptide (BNP), erythrocyte sedimentation rate (ESR), and LAd/∆LVED (LAd=left atrial diameter; ∆LVED= left ventricular end-diastolic diameter-left ventricular end-systolic diameter). Severe SEC group had a higher peri-procedure ischemic event occurrence. (7.1%vs. 1.9%, P=0.007). At a median follow-up of 55 months, severe SEC group had a lower freedom rate from ischemic events (90.1% vs. 75.3%, P<0.001); older age and severe SEC were independent risk factors for ischemic events. In patients undergoing redo-procedure (n=100), a remarkably reduced ESR (17.8±12.0 mm/h vs. 28.2±19.0 mm/h, P<0.001) was observed in patients whose SEC disappeared. Conclusions Higher BNP, ESR, LAd/∆LVED were the independent predictors for severe SEC. Severe SEC were associated with higher peri-procedural and long-term ischemic risks. ESR and LAd/∆LVED, as indicators of hematological and hemodynamic change, seemed helpful in identifying NVAF patients prone to developing severe SEC.

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Section: Discussioncontrasting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Severe Left Atrial Spontaneous Echo Contrast in Nonvalvular Atrial Fibrillation: Clinical Characteristics and Impact on Ischemic Risk Postablation

Wang

Chen

et al. 2022

Thromb Haemost

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“…На шансы выявления тромба в УЛП у больных с ФП оказывает влияние и клиническая оценка риска инсульта [7,8]. По нашим данным, высокий риск инсульта повышает шансы тромбоза УЛП в 2,90 (1,84-4,56) раза как у больных, получающих адекватную АКТ, так и у больных такой терапии не получающих.…”

Section: Discussionunclassified

“…Кардиоваскулярная терапия и профилактика. 2021;20 (7):2783. doi:10.15829/1728-8800-2021-2783 ISSN 1728-8800 (Print) ISSN 2619-0125 (Online) О возможности использования оценки риска инсульта у больных с персистирующей фибрилляцией предсердий для решения вопроса о целесообразности проведения чреспищеводной эхокардиографии перед кардиоверсией Мазур Е. С., Мазур В. В., Баженов Н. Д., Орлов Ю. А.…”

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Stroke risk assessment in patients with persistent atrial fibrillation to consider performing pre-cardioversion transesophageal echocardiography

Мазур

Bazhenov

et al. 2021

Cardiovasc Ther Prev

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Aim. To study the potential of stroke risk assessment to evaluate the probability of detecting left atrial appendage (LAA) thrombus in patients with persistent atrial fibrillation (AF) to consider performing transesophageal echocardiography (TEE) before cardioversion.Material and methods. TEE before elective cardioversion was performed in 590 patients with persistent AF, of whom 316 (53,6%) had a high stroke risk (valvular AF, hypertrophic cardiomyopathy, CHA2DS2-VASc score >1 in men and >2 in women), and 274 (46,4%) — not high. Adequate anticoagulation at least 3 weeks prior to elective cardioversion was received by 164 (51,9%) patients with a high stroke risk and 151 (55,1%) patients with a low risk. The rest of patients either did not receive adequate anticoagulation or received it for less than 3 weeks.Results. In the group of patients who received anticoagulation at least 3 weeks, LAA thrombus was detected in 23 (14,0%) patients with a high stroke risk and in 8 (5,3%) patients with a low risk (p<0,05). In patients who did not receive adequate anticoagulation or received it for less than 3 weeks, LAA thrombus was identified in 60 (39,5%) patients with a high stroke risk and in 22 (17,9%) patients with a low risk (p<0,005). Thus, a high stroke risk almost 3 times increases the likelihood of LAA thrombus detection in patients who did not receive adequate anticoagulation (odds ratio, 2,99; 95% confidence interval: 1,70-5,26;p<0,001) and in patients receiving adequate anticoagulation (odds ratio, 2,92; 95% confidence interval: 1,26-6,74; p=0,012).Conclusion. In patients with persistent AF with a low stroke risk according to CHA2DS2-VASc score, TEE before sinus rhythm restoration in patients without 3-week anticoagulation should be considered. In patients with a high stroke risk, performing pre-cardioversion TEE is advisable even after adequate anticoagulation.

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“…Поиску предикторов предсердного тромбоза у больных персистирующей ФП посвящены многочисленные исследования, выявившие связь предсердного тромбообразования с разнообразными факторами, начиная от группы крови и заканчивая морфологическим особенностями УЛП [3][4][5]. Особенно активно изучается возможность использования для прогнозирования вероятности предсердного тромбоза оценки риска инсульта по шкале CHA 2 DS 2 -VASc (Congestive heart failure, Hypertension, Age, Diabetes mellitus, Stroke, Vascular disease, Age, Sex category) [6]. Однако такая оценка не обеспечивает достаточной точности прогнозирования предсердного тромбоза [6], что побуждает одних исследователей модифицировать эту шкалу за счет добавления дополнительных предикторов [7][8][9], а других -разрабатывать собственные прогностические шкалы [10].…”

Section: Introductionunclassified

Predictors of atrial thrombosis of persistent nonvalvular atrial fibrillation

Mazur,

Bazhenov

et al. 2023

Medicinskij sovet

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Introduction. The clinical significance of atrial fibrillation (AF) is associated with the development of thromboembolic complications that occur when thrombus from the left atrial appendage enter the systemic circulation. Transesophageal echocardiography can detect the left atrial appendage thrombus, but due to lack of availability, high cost and complexity of performing such a routine examination is unlikely. Therefore, the search for predictors of the left atrial appendage thrombosis is relevant, the presence of which may become the basis for a more in-depth instrumental examination of patients with AF.Aim. To identify predictors of atrial thrombosis in patients with persistent nonvalvular atrial fibrillation.Materials and methods. The 551 patients with persistent nonvalvular atrial fibrillation underwent transesophageal echocardiography before cardioversion, thrombus in the left atrial appendage was detected in 74 (13.4%) patients. All patients were selected into training (400 people) and validation (151 people) cohorts randomly. Multivariate logistic regression analysis was performed to identify predictors of atrial thrombosis in the derivation cohort.Results. Five factors influenced the atrial thrombosis independently. They are the ratio of the transmitral velocity to the mitral annulus early Diastolic velocity (E/e’) ≥ 12 (D), the absence or inadequate Anticoagulant therapy (A), atrial Fibrillation, not flutter (F), left atrial volume Index (I), and age ≥ 75 years (DAFI75 scale). The number of predictors corresponds the risk of detecting atrial thrombosis: the area under the characteristic curve was 0.818 (0.768–0.868) in the derivation cohort and 0.847 (0.761–0.934) in the validation cohort. The sensitivity of the DAFI75 criterion ≥ 3 in the derivation and validation cohorts is 91.7 and 92.9%, the specificity is 58.8 and 65.7%, the predictive value of a positive result is 28.2 and 21.7%, and the predictive value of a negative result is 97.6 and 98.9%.Conclusion. The presence of three or more predictors score DAFI75 allows predicting the absence of atrial thrombosis more than in 97% of case.

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CHA₂DS₂-VASc Score as a Predictor for Left Atrial Thrombus or Spontaneous Echo Contrast in Patients with Nonvalvular Atrial Fibrillation: A Meta-Analysis

Cited by 8 publications

References 30 publications

Severe Left Atrial Spontaneous Echo Contrast in Nonvalvular Atrial Fibrillation: Clinical Characteristics and Impact on Ischemic Risk Postablation

Severe Left Atrial Spontaneous Echo Contrast in Nonvalvular Atrial Fibrillation: Clinical Characteristics and Impact on Ischemic Risk Postablation

Stroke risk assessment in patients with persistent atrial fibrillation to consider performing pre-cardioversion transesophageal echocardiography

Predictors of atrial thrombosis of persistent nonvalvular atrial fibrillation

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CHA2DS2-VASc Score as a Predictor for Left Atrial Thrombus or Spontaneous Echo Contrast in Patients with Nonvalvular Atrial Fibrillation: A Meta-Analysis

Cited by 8 publications

References 30 publications

Severe Left Atrial Spontaneous Echo Contrast in Nonvalvular Atrial Fibrillation: Clinical Characteristics and Impact on Ischemic Risk Postablation

Severe Left Atrial Spontaneous Echo Contrast in Nonvalvular Atrial Fibrillation: Clinical Characteristics and Impact on Ischemic Risk Postablation

Stroke risk assessment in patients with persistent atrial fibrillation to consider performing pre-cardioversion transesophageal echocardiography

Predictors of atrial thrombosis of persistent nonvalvular atrial fibrillation

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CHA₂DS₂-VASc Score as a Predictor for Left Atrial Thrombus or Spontaneous Echo Contrast in Patients with Nonvalvular Atrial Fibrillation: A Meta-Analysis