Cheating the CHA2DS2-VASc Score: Thromboembolism in Apical Hypertrophic Cardiomyopathy

Area of Science:

• Cardiology
• Thrombosis
• Genetics

Background:

• Atrial fibrillation (AF) elevates systemic thromboembolism and stroke risk.
• Risk stratification scores (CHADS2, CHA2DS2-VASc) guide anticoagulation decisions.
• Certain conditions, like hypertrophic cardiomyopathy (HCM), pose risks not captured by current scores.

Purpose of the Study:

• To highlight the thromboembolic risk associated with apical hypertrophic cardiomyopathy (AHCM) in patients with atrial fibrillation.
• To suggest modifications to existing stroke risk scores to include cardiomyopathy-related risks.

Main Methods:

• Case report presentation.
• Review of existing risk stratification models for atrial fibrillation-related stroke.
• Clinical assessment of a patient with AHCM and AF.

Main Results:

• A patient with AHCM and AF experienced severe thromboembolic events despite a low CHA2DS2-VASc score.
• The CHA2DS2-VASc score did not accurately reflect the patient's thromboembolic risk.

Conclusions:

• Apical hypertrophic cardiomyopathy increases thromboembolic risk in atrial fibrillation patients.
• Current stroke risk scores may need revision to incorporate risks from specific cardiomyopathies.
• Consideration of anticoagulation in AF patients with AHCM is crucial, irrespective of standard risk scores.