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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Possible refinement of clinical thromboembolism assessment in patients with atrial fibrillation using
Rui Providência1, Ana Botelho, Joana Trigo
1Cardiology Department, Coimbra's Hospital Center and University, Coimbra, Portugal. rui_providencia@yahoo.com
Insights
Transthoracic echocardiogram (TTE) parameters improve stroke risk prediction in atrial fibrillation (AF) patients. Adding TTE findings to CHADS(2) and CHA(2)DS(2)-VASc scores enhances detection of stroke risk markers.
Area of Science:
- Cardiology
- Medical Imaging
- Stroke Prevention
Background:
- Certain transesophageal echocardiogram (TEE) findings correlate with increased stroke risk in atrial fibrillation (AF) patients.
- Existing clinical risk scores like CHADS(2) and CHA(2)DS(2)-VASc are used for stroke risk stratification in AF.
Purpose of the Study:
- To evaluate and compare the accuracy of CHADS(2) and CHA(2)DS(2)-VASc scores in predicting specific TEE findings associated with stroke risk.
- To assess the additive value of transthoracic echocardiogram (TTE)-derived parameters in refining these clinical risk classifications.
Main Methods:
- A cross-sectional study involving 405 consecutive AF patients who underwent both TTE and TEE.
- Stroke risk was assessed using CHADS(2) and CHA(2)DS(2)-VASc scores, with and without TTE parameters (left atrium area, left ventricle global systolic function).
- Comparisons of left atrial appendage thrombi (LAA T), dense spontaneous echo contrast (SEC), and LAA low flow velocities (LFV) were made using receiver operating characteristic curves.
Main Results:
- No significant differences were observed between CHADS(2) and CHA(2)DS(2)-VASc in predicting LAA T, dense SEC, and LAA LFV.
- In patients classified as low-risk by CHADS(2) alone, 10% exhibited high-risk TEE findings.
- The addition of TTE-derived parameters to clinical risk scores significantly improved the prediction of TEE-identified stroke risk markers.
Conclusions:
- TTE-derived parameters offer a valuable method for refining existing clinical risk schemes to detect stroke surrogate markers in AF patients.
- Further follow-up studies with clinical endpoints are needed to validate these findings and confirm their clinical utility.
Aim:
Some transoesophageal echocardiogram (TEE) findings are associated with an increased risk of stroke in patients with atrial fibrillation (AF). This study was designed to evaluate and compare the accuracy of CHADS(2) and CHA(2)DS(2)-VASc in the prediction of these findings and test the additive value of transthoracic echocardiogram (TTE)-derived parameters as a possible refinement for these classifications.
Methods And Results:
Cross-sectional study of 405 consecutive patients who underwent TTE and TEE evaluation during AF. Stroke risk assessment was performed using the CHADS(2) and CHA(2)DS(2)-VASc scores, alone and alongside with the addition of two TTE-derived parameters (left atrium area and left ventricle global systolic function). Comparisons regarding the presence of left atrial appendage thrombi (LAA T), dense spontaneous echo contrast (SEC), and left atrial appendage (LAA) low flow velocities (LFV) were performed using receiver operating characteristic curves. In low-risk patients, as assessed through the CHA(2)DS(2)-VASc score and CHADS(2) and CHA(2)DS(2)-VASc scores plus echo parameters, no high-risk features were found on TEE. In subjects classified as low risk using CHADS(2), this figure rose to 10%. No significant differences were found between CHADS(2) and CHA(2)DS(2)-VASc in the prediction of LAA T, dense SEC, and LAA LFV. The addition of TTE-derived parameters to the previous clinical-risk scores resulted in improved prediction of the TEE endpoints.
Conclusion:
These findings suggest that the use of TTE-derived parameters may be a valuable way of refining the available clinical risk schemes for the detection of surrogate markers of stroke. Follow-up studies using clinical endpoints will be necessary to confirm this hypothesis.
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