Refinement of CHADS2 and CHA2DS2-VASc scores predict left atrial thrombus or spontaneous echo contrast in nonvalvular atrial fibrillation patients

Abstract

Objective To investigate the risk factors of left atrial thrombus (LAT)/spontaneous echo contrast (SEC) in patients with nonvalvular atrial fibrillation (AF). Methods This retrospective study analysed the data from consecutive patients with nonvalvular AF that underwent transoesophageal echocardiography. Logistic regression analysis was performed to identify risk factors of LAT/SEC. Receiver operating characteristic curve analysis was undertaken compare the new scales with CHADS2 and CHA2DS2-VASc scores. Results A total of 558 patients with AF were included in the study. LAT/SEC was detected in 137 (24.6%) patients. The independent risk factors of LAT/SEC beyond CHADS2 or CHA2DS2-VASc scores included non-paroxysmal AF and left atrial diameter >37.5 mm. These two variables were added into the CHADS2 or CHA2DS2-VASc score to build new scales. Areas under the curve for the new scales based on CHADS2 and CHA2DS2-VASc scores were significantly higher than the CHADS2 or CHA2DS2-VASc score both in the overall study cohort and in patients at a high risk of thromboembolism. Conclusions Non-paroxysmal AF and increased left atrial diameter beyond the CHADS2 or CHA2DS2-VASc score were independent risk factors of LAT/SEC and may help to improve the current risk stratification, especially for patients with nonvalvular AF at a high risk of thromboembolism.

Finding low CHA2DS2-VASc scores unreliable? Why not give morphological and hemodynamic methods a try?

“…Left atrial diameter (LAD) was found to have an AUC generally over 0.7 in AF patients, with relatively balanced specificity and sensitivity. One study about low-score patients reported an AUC of 0.878 (cutoff point 43.5 mm, sensitivity 84.4%, specificity 74.7%), and if we bind LAD with CHA2DS2-VASc, we were still able to obtain a much better predictive value (AUC 0.747 vs. 0.541) ( 19 , 31 , 34 , 36 , 51 ). Left atrium top and bottom diameter (LTD) also has a decent value (AUC 0.705, sensitivity 75.7%, specificity 73.7%), which is not as good as LAD.…”

“…At present, the CHA2DS2-VASc score [previous stroke, 2 points; age: ≥75 years, 2 points; age: 65–74 years, 1 point; congestive heart failure, 1 point; hypertension, 1 point; diabetes mellitus, 1 point; vascular disease, 1 point; sex (female), 1 point] is the most commonly used scoring system for the risk stratification of stroke in patients with AF, and it even exhibits some predictive value in patients with sinus rhythm ( 19 , 20 ). It has been recommended in the European guidelines as class I for risk stratification in patients with AF.…”

Clinical case of Cor triatriatum sinister, a dilemma of anticoagulation: A case report and literature review

“…Furthermore, previous studies have provided evidence indicating that left atrial thrombus is associated with many other variables, including left atrial diameter above 37.5 mm, LAA structure, left ventricular mass, estimated GFR below 60 mL/min/1.73 m 2 , and left ventricular EF. 11 , 12 …”

“…CHA2DS2‐VASc consists of Several clinical risk factors, including age, sex, congestive heart failure, hypertension, diabetes mellitus, stroke/transient ischemic attack, and vascular disease. Furthermore, previous studies have provided evidence indicating that left atrial thrombus is associated with many other variables, including left atrial diameter above 37.5 mm, LAA structure, left ventricular mass, estimated GFR below 60 mL/min/1.73 m 2 , and left ventricular EF 11,12 …”

Validation of a predictive model of the left atrium appendage thrombosis in patients with nonvalvular atrial fibrillation

“…Другим фактором риска наличия тромбоза УЛП в нашем исследовании явилась персистирующая форма ФП. Это согласуется с результатами исследования M. Cao и соавт., где наличие ФП в течение 7 и более дней повышало риск тромбоза УЛП в 2,2 раза (ОШ 2,201; 95% ДИ 1,418-3,415; р < 0,001) [9]. В метаанализе A. Lurie и соавт.…”