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[CHADS₂versus CHA₂DS₂-VASc scoring systems for predicting left atrial thrombus in patients with nonvalvular atrial
Jun Gu1, Fengpeng Jia, Panpan Feng
1Department of Cardiovascular Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
Insights
The CHA2DS2-VASc score is a more effective tool than the CHADS2 score for predicting left atrial thrombus in patients with nonvalvular atrial fibrillation. This enhanced risk stratification identifies more high-risk individuals, improving patient management.
Area of Science:
- Cardiology
- Thrombosis Research
- Medical Scoring Systems
Background:
- Nonvalvular atrial fibrillation (NVAF) poses a significant risk for left atrial thrombus (LAT) formation.
- Accurate risk stratification is crucial for preventing thromboembolic events in NVAF patients.
- Existing scoring systems, such as CHADS2, have limitations in predicting LAT.
Purpose of the Study:
- To compare the predictive accuracy of the CHADS2 and CHA2DS2-VASc scoring systems for LAT in NVAF patients.
- To evaluate the differences in risk stratification between the two scoring systems.
- To identify independent risk factors for LAT in this population.
Main Methods:
- A cohort of 397 NVAF patients underwent assessment using both CHADS2 and CHA2DS2-VASc scoring systems.
- Transesophageal echocardiography (TEE) was utilized to detect the presence of LAT.
- Statistical analyses, including univariate and multivariate logistic regression, were performed to compare scores and identify risk factors.
Main Results:
- CHA2DS2-VASc scores were significantly higher than CHADS2 scores (1.37 ± 1.19 vs 0.63 ± 0.78, P<0.001).
- CHA2DS2-VASc identified a significantly larger proportion of high-risk patients (P<0.001).
- LAT was detected in 44 patients, with prevalence increasing significantly with higher risk scores from both systems (P<0.05). Multivariate analysis identified CHA2DS2-VASc ≥ 2 as the sole independent predictor of LAT (OR=9.85, P < 0.01).
Conclusions:
- The CHA2DS2-VASc score demonstrates superior predictive performance for LAT compared to the CHADS2 score in NVAF patients.
- CHA2DS2-VASc offers improved risk stratification, identifying more patients at high risk for LAT.
- Utilizing CHA2DS2-VASc can enhance clinical decision-making for anticoagulation therapy in NVAF.
Objective:
To assess the correlation of CHADS₂and CHA₂DS₂-VASc scores for left atrial thrombus in patients with nonvalvular atrial fibrillation and the differences in the results between the two scoring systems.
Methods:
A total of 397 patients with nonvalvular atrial fibrillation were enrolled in this study. The CHADS₂and CHA2DS2-VASc scoring systems were used for evaluating the risk of left atrial thrombus and their differences in the scores and risk stratifications were compared. The correlation of CHADS₂ and CHA₂DS₂-VASc scores with left atrial thrombus was analyzed.
Results:
The average score of CHA₂DS₂-VASc was significantly higher than that of CHADS₂in these patients (1.37 ± 1.19 vs 0.63 ± 0.78, P<0.001). The proportion of high-risk group was significantly higher (P<0.001) while that of low-risk group significantly lower as stratified by CHA₂DS₂-VASc scores than by CHADS₂scores (P<0.001). Transesophageal echocardiography detected left atrial thrombus in 44 of the total patients. The prevalence of left atrial thrombus increased significantly with a higher risk stratification by CHADS₂or CHA₂DS₂-VASc scores (P<0.05). Univariate analysis showed that female gender, age ≥ 65 years, left atrium diameter ≥ 38 mm, left ventricular ejection fraction ≤ 40%, hypertension, diabetes, coronary heart disease, stroke history, CHADS₂≥ 2, and CHA₂DS₂-VASc ≥ 2 were all correlated with left atrial thrombus, but multivariate logistic analysis identified only CHA₂DS₂-VASc ≥ 2 as the independent risk factor for left atrial thrombus (OR=9.85, 95% CI: 2.178-44.542, P < 0.01).
Conclusion:
The average score of CHA₂DS₂-VASc is higher than that of CHADS₂and has better predictive ability for left atrial thrombus.
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