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Is CHA2DS2-VASc appropriate for hyperthyroid patients with atrial fibrillation? Implications of adding a

Marcus Vinicius Leitão de Souza1, Patricia de Fátima Dos Santos Teixeira1, Mario Vaisman1

  • 1Division of Endocrinology, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.

International Journal of Cardiology
|December 3, 2016
PubMed

Insights

Hyperthyroid patients with atrial fibrillation often have a thrombogenic milieu, a blood clot risk, detected by transesophageal echocardiography (TEE). This risk did not correlate with the CHA2DS2-VASc score, suggesting TEE provides crucial data for anticoagulation decisions.

Area of Science:

  • Cardiology
  • Endocrinology
  • Medical Imaging

Background:

  • Anticoagulation in hyperthyroid patients with atrial fibrillation (AF) is debated.
  • The thrombogenic milieu (TM) prevalence in these patients is evaluated.
  • Correlation with clinical embolic risk (CHA2DS2-VASc) is assessed.

Purpose of the Study:

  • To determine the prevalence of thrombogenic milieu (TM) in hyperthyroid patients with AF.
  • To correlate TM findings with the CHA2DS2-VASc score.
  • To explore the role of transesophageal echocardiography (TEE) in risk assessment.

Main Methods:

  • 47 patients (18-65 years) with AF and hyperthyroidism underwent TEE.
  • TM defined by spontaneous echo contrast, thrombi, or low LAA flow velocity (<0.20m/s).
  • CHA2DS2-VASc score, thyroid status, and diagnosis duration were recorded.

Main Results:

  • Pulmonary hypertension (81.4%) and TM (46.8%) were highly prevalent.
  • TM presence did not correlate with CHA2DS2-VASc scores (low or high).
  • Longer hyperthyroidism duration (>12 months) was linked to non-classic TM.

Conclusions:

  • Pulmonary hypertension and TM are common in younger hyperthyroid AF patients.
  • CHA2DS2-VASc score inadequately reflects TM risk in this population.
  • TEE offers valuable insights beyond clinical scores for antithrombotic therapy decisions.
Abstract

Keywords:
Atrial fibrillationCHA(2)DS(2)-VAScHyperthyroidismPulmonary hypertensionThrombogenic milieuTransesophageal echocardiography

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