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Association of Thromboembolic Risk Score with Left Atrial Thrombus and Spontaneous Echocardiographic Contrast in

Jun Huang1, Hong-Tao Liao2, Hong-Wen Fei2

  • 1Department of Geriatrics, Guangdong General Hospital, Institute of Geriatrics, Guangdong Academy of Medical Sciences, Guangzhou, China.

Cardiology
|June 20, 2018
PubMed

Insights

Existing scores like CHADS2 and CHA2DS2-VASc are poor predictors of left atrial thrombus (LAT) and spontaneous echocardiographic contrast (SEC) in nonvalvular atrial fibrillation (NVAF) patients. A new scoring system using AF type and echocardiographic data shows improved prediction for these risks.

Area of Science:

  • Cardiology
  • Medical Diagnostics
  • Thrombosis Research

Background:

  • Nonvalvular atrial fibrillation (NVAF) patients are at risk for cardioembolic events.
  • Left atrial thrombus (LAT) and spontaneous echocardiographic contrast (SEC) are indicators of this risk.
  • Current scoring systems like CHADS2 and CHA2DS2-VASc have limitations in predicting these findings.

Purpose of the Study:

  • To evaluate the association of CHADS2/CHA2DS2-VASc scores with LAT/SEC in non-anticoagulated NVAF patients.
  • To develop and validate a novel scoring system for predicting LAT/SEC.
  • To identify key predictors for LAT/SEC in this patient cohort.

Main Methods:

  • A retrospective analysis of 2,173 consecutive non-anticoagulated NVAF patients.
  • Transesophageal echocardiography was used to detect LAT/SEC.
  • Multivariate analysis and receiver operating characteristic (ROC) curve analysis were employed.

Main Results:

  • The prevalence of LAT/SEC was 4.9% in the study population.
  • CHADS2 and CHA2DS2-VASc scores demonstrated low-to-moderate predictive value for LAT/SEC (ROC 0.591 and 0.608).
  • Non-paroxysmal AF, reduced left ventricular ejection fraction, and left atrial enlargement were significant predictors, leading to a new scoring system with improved discrimination (ROC 0.792).

Conclusions:

  • CHADS2/CHA2DS2-VASc scores have limited utility in predicting LAT/SEC in non-anticoagulated NVAF patients.
  • A new scoring system incorporating AF type and echocardiographic parameters offers superior prediction of LAT/SEC.
  • This novel system may serve as a better surrogate for cardioembolic risk assessment in NVAF.
Abstract

Keywords:
CHA2DS2-VASc scoreCHADS2 scoreLeft atrial thrombusNonvalvular atrial fibrillationSpontaneous echocardiographic contrast

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