A novel scoring system for stroke risk stratification in Japanese patients with low CHADS2 scores: Study using a
Daigo Nagahara1, Naoyuki Kamiyama1, Takefumi Fujito1
1Department of Cardiovascular, Renal and Metabolic Medicine Sapporo Medical University School of Medicine Sapporo Japan.
Insights
A new TEE-risk score effectively predicts stroke risk in atrial fibrillation (AF) patients with low CHADS2 scores. This score, combining left atrial diameter, BNP, CT findings, and AF type, improves risk stratification beyond the CHADS2 score.
Area of Science:
- Cardiology
- Medical Imaging
- Clinical Risk Stratification
Background:
- Catheter ablation for atrial fibrillation (AF) carries perioperative thromboembolism risk, even in low-CHADS2 score patients.
- Transesophageal echocardiography (TEE) assesses stroke risk factors, but predicting these factors using clinical variables needs investigation.
Purpose of the Study:
- To determine if a combination of clinical variables can predict stroke risk factors identified by TEE in AF patients.
- To develop and validate a new scoring system for stroke risk prediction in low-risk AF patients.
Main Methods:
- 209 AF patients with CHADS2 scores of 0 or 1 underwent TEE.
- TEE-determined stroke risk included cardiac thrombus/sludge, dense spontaneous echo contrast (SEC), and/or peak left atrial appendage (LAA) flow velocity <0.25 m/s.
- Multivariate logistic analysis identified predictors for TEE risk, leading to the development of the TEE-risk score.
Main Results:
- 10.5% of patients exhibited TEE-determined stroke risk.
- Independent predictors of TEE risk were persistent AF, left atrial diameter (LAD), contrast medium defect (CMD) in the LAA on CT, and serum brain natriuretic peptide (BNP) level.
- The novel TEE-risk score (based on LAD, BNP, CMD, and persistent AF) demonstrated a superior area under the curve (0.852) for predicting TEE risk compared to the modified CHADS2 score (0.631).
Conclusions:
- The TEE-risk score is a reliable predictor of TEE-determined stroke risk in AF patients with low CHADS2 scores.
- Combining the TEE-risk score with the CHADS2 score may enhance stroke risk stratification in this patient population.
Background:
Catheter ablation is an effective treatment for atrial fibrillation (AF), but it carries risk of perioperative thromboembolism even in cases with low CHADS2 scores. Here, we examined whether a combination of clinical variables can predict stroke risk factors that are assessed by transesophageal echocardiography (TEE).
Methods:
The study population consisted of 209 consecutive AF patients with a CHADS2 score of 0 or 1 (58.7 ± 10.6 years old; persistent AF, 33.0%). All patients underwent TEE, and TEE-determined stroke risk (TEE risk) was defined as cardiac thrombus/sludge, dense spontaneous echo contrast (SEC), and/or peak left atrial appendage (LAA) flow velocity <0.25 m/s.
Results:
Transesophageal echocardiography risk was observed in 10.5% of the patients. In multivariate logistic analysis, persistent AF [odds ratio (OR): 11.5, CI: 3.14-42.1, P = .0002], left atrial diameter (LAD) (OR: 1.10, CI: 1.01-1.20, P = .0293), contrast medium defect (CMD) in the LAA detected by computed tomography (OR: 20.2, CI: 6.3-65.0, P < .0001), and serum brain natriuretic peptide (BNP) level (OR: 1.00, CI: 1.00-1.01, P = .0056) were independent predictors of TEE risk. A new scoring system comprising LAD > 41 mm (1 point), BNP > 47 pg/mL (1 point), CMD (2 points), and persistent AF (2 points) was constructed and defined as TEE-risk score. The area under the curve (AUC) for prediction of TEE risk was 0.631 in modified CHADS2 score and it was 0.852 in TEE-risk score.
Conclusion:
Transesophageal echocardiography risk is predictable by TEE-risk score, and its combination with CHADS2 score may improve the stroke risk stratification in AF patients with a low CHADS2 score.
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