Inverse Correlation Between Left Atrial Appendage Function and CHA₂DS₂-VASc Score in Patients with Atrial Flutter

Area of Science:

• Cardiology
• Vascular Medicine
• Echocardiography

Background:

• Left atrial appendage (LAA) dysfunction, characterized by impaired ejection fraction (LAA-EF) and flow velocity (LAA-FV), is a known risk factor for thromboembolic events in atrial fibrillation (AF).
• Atrial flutter (AFL) shares similarities with AF, and understanding LAA function in AFL patients, particularly those with coexisting AF, is crucial for risk stratification.

Purpose of the Study:

• To investigate LAA function in patients with typical atrial flutter (AFL) stratified by CHA2DS2-VASc score.
• To compare LAA function between isolated AFL and AFL with paroxysmal AF (PAF) groups.
• To explore the correlation between LAA function and thromboembolic risk scores in AFL patients.

Main Methods:

• Transesophageal echocardiography (TEE) was used to assess LAA-EF and LAA-FV in 231 consecutive patients with typical AFL.
• Patients were categorized into isolated AFL, AFL with PAF, and control groups (spontaneous sinus rhythm).
• Statistical analyses were performed to compare LAA function parameters and assess correlations with the CHA2DS2-VASc score.

Main Results:

• Patients with AFL and PAF exhibited significantly lower LAA-FV (31.9 cm/s vs. 51.5 cm/s) and LAA-EF (28.4% vs. 36.5%) compared to those with isolated AFL.
• A significant inverse correlation was found between CHA2DS2-VASc score and LAA-EF in both AFL and AFL+PAF groups.
• Progressive LAA dysfunction was observed in patients with AFL+PAF, with LAA-EF inversely related to the CHA2DS2-VASc score.

Conclusions:

• Patients with atrial flutter and coexisting paroxysmal atrial fibrillation demonstrate impaired left atrial appendage function.
• Left atrial appendage dysfunction in these patients is associated with an increased risk of thromboembolic events, as indicated by the CHA2DS2-VASc score.
• These findings highlight the importance of assessing LAA function in AFL patients for optimizing thromboprophylactic therapy strategies.