Improvement of Predictive Value for Thromboembolic Risk by Incorporating Left Atrial Functional Parameters in the CHADS2 and CHA2DS2-VASc Scores
Related Experiment Video
Updated: Apr 14, 2026
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Mi-Na Kim1, Su-A Kim, Jong-il Choi
1Division of Cardiology, Korea University Anam Hospital.
Insights
Adding echocardiographic measures to atrial fibrillation risk scores improves prediction of blood clots. Combining impaired left atrial function with CHADS2 or CHA2DS2-VASc scores enhances embolic risk assessment in AF patients.
Area of Science:
- Cardiology
- Internal Medicine
- Medical Imaging
Background:
- Atrial fibrillation (AF) poses a significant risk of thromboembolism.
- Current risk stratification scores like CHADS2 and CHA2DS2-VASc have modest predictive ability.
- Echocardiographic parameters are recognized risk factors for thromboembolic events.
Purpose of the Study:
- To assess if combining echocardiographic parameters with CHADS2 and CHA2DS2-VASc scores improves embolic risk prediction in AF patients.
- To evaluate the predictive power of clinical scores versus echocardiographic parameters for left atrial thrombus or dense spontaneous echo contrast (SEC).
Main Methods:
- A total of 526 non-valvular AF patients were enrolled.
- Predictability for left atrial (LA) thrombus or dense SEC was assessed using clinical scores, echocardiographic parameters, and combined approaches.
- Statistical analysis included calculating c-statistics to compare predictive powers.
Main Results:
- The predictive power of CHADS2 and CHA2DS2-VASc scores alone for LA thrombus/dense SEC was modest (c-statistics 0.65 and 0.68).
- Impaired left atrial (LA) function (LA emptying fraction < 30%) emerged as the most significant echocardiographic predictor.
- Combining impaired LA function with CHADS2 and CHA2DS2-VASc scores significantly improved prediction (c-statistics 0.78 and 0.77).
Conclusions:
- Incorporating LA functional markers enhances the predictive value of CHADS2 and CHA2DS2-VASc scores for detecting thrombus or dense SEC.
- Anticoagulation should be considered for AF patients with low-risk scores but also exhibiting LA dysfunction to prevent embolism.
Abstract:
The discriminative ability of the widely used CHADS2 and CHA2DS2-VASc scores for risk stratification of thromboembolism in atrial fibrillation (AF) is known as modest. Some echocardiographic parameters are known risk factors for thromboembolism. This study aimed to evaluate whether combining echocardiographic parameters with CHADS2 and CHA2DS2-VASc scores can improve the predictive power for embolic risk in AF.A total of 526 (F/M = 83/433, mean age = 57.6 ± 10.7 years) patients with non-valvular AF were enrolled. The predictability for left atrial (LA) thrombus or dense spontaneous echo contrast (SEC) using clinical scores or echocardiographic parameters or combining clinical scores and echocardiographic parameters was calculated and compared.Dense SEC or thrombus was present in 51 patients. The predicting powers of the CHADS2 and CHADS2-VASc scores for the presence of dense SEC or thrombus were modest (c-statistics 0.65 and 0.68, respectively, 95% confidence interval [CI] 0.61-0.69 and 0.64-0.74, respectively, both P < 0.001). Impaired LA function was the most descriptive predictor for the presence of thrombus or dense SEC among echocardiographic parameters. Combining impaired LA function (LA emptying fraction < 30%) with the CHADS2 and CHA2DS2-VASc scores showed the improvement of predictive power in detecting dense SEC or thrombus (c-statistics 0.78 and 95% CI 0.74-0.81 and c-statistics 0.77 and 95% CI 0.73-0.81, respectively, both P < 0.001).Adding LA functional markers to the CHADS2 or CHA2DS2-VASc score improved the predictive value of the presence of thrombus or dense SEC. In clinical situations, anticoagulation should be considered to prevent embolism in patients with low-risk scores when they have LA dysfunction.
