Related Experiment Video
Updated: Dec 11, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Determinants of left atrial thrombus or spontaneous echo contrast in nonvalvular atrial fibrillation
Deheng Han1, Yanan Chu1, Yakui Wu1
1Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Insights
New research shows existing stroke risk scores like CHADS₂ and CHA₂DS₂-VASc are insufficient for predicting left atrial thrombus (LAT) or spontaneous echo contrast (SEC) in atrial fibrillation (AF) patients. A novel scale incorporating renal dysfunction and left atrial enlargement demonstrates improved prediction accuracy for LAT/SEC.
Area of Science:
- Cardiology
- Medical Diagnostics
- Thrombosis Research
Background:
- Established CHADS₂ and CHA₂DS₂-VASc scores predict stroke risk in atrial fibrillation (AF).
- Their predictive power for left atrial thrombus (LAT) or spontaneous echo contrast (SEC) remains underexplored.
- Accurate prediction of LAT/SEC is crucial for refining thromboembolic risk stratification in AF patients.
Purpose of the Study:
- To evaluate the predictive capability of CHADS₂ and CHA₂DS₂-VASc scores for LAT/SEC.
- To identify novel clinical, echocardiographic, and laboratory predictors of LAT/SEC.
- To develop a new, more accurate scale for predicting LAT/SEC in nonvalvular AF.
Main Methods:
- Analysis of 1102 consecutive AF patients undergoing transesophageal echocardiography (TEE).
- Collection of clinical, echocardiographic, and laboratory data from electronic medical records.
- Multivariate logistic analysis and receiver operating characteristic (ROC) curve analysis to identify predictors and assess score performance.
Main Results:
- Prevalence of LAT/SEC was 4.36% in the study cohort.
- Hypertension, left atrial enlargement, prior stroke/TIA, left ventricular dysfunction, and renal dysfunction were significant predictors of LAT/SEC.
- A newly derived scale achieved a higher c-statistic (0.761) for LAT/SEC prediction compared to CHADS₂ (0.673) and CHA₂DS₂-VASc (0.643).
Conclusions:
- Renal dysfunction and left atrial enlargement, not in CHA₂DS₂-VASc, are independent predictors of LAT/SEC.
- A new scale integrating clinical, echocardiographic, and laboratory factors may enhance thromboembolic risk stratification.
- Further prospective, multicenter studies are needed to validate the new scale and its clinical applicability.
Background:
The CHADS2 and CHA2DS2-VASc scores are well-established clinical scales to estimate the risk of stroke in patients with atrial fibrillation (AF). However, the predictive power of the two scales concerning left atrial thrombus (LAT) or spontaneous echo contrast (SEC) has not been well investigated. Therefore, we investigated the predict power of CHADS2 and CHA2DS2-VASc scores concerning LAT/SEC; identified clinical, echocardiographic and laboratory predictors of LAT/SEC in addition to the CHADS2 and CHA2DS2-VASc scores; and derived a new scale to predict LAT/SEC accurately, it might improve thromboembolic risk stratification in patients with nonvalvular atrial fibrillation.
Methods:
We identified 1102 consecutive AF patients who underwent transesophageal echocardiography (TEE) for the purpose of the exclusion of LAT before catheter ablation, cardioversion or left atrial appendage occlusion. The clinical, echocardiographic and laboratory characteristics of patients were collected from the electronic medical record system.
Results:
In the study, the prevalence of LAT/SEC was only 4.36%. In the multivariate logistic analysis, hypertension, left atrial enlargement, prior stroke/TIA, left ventricular dysfunction, and renal dysfunction were predictors of LAT/SEC. Receiver operating characteristic curve analysis showed that c-statistics of the CHADS2 and CHA2DS2-VASc scores concerning LAT/SEC were 0.673 and 0.643, respectively. We derived a new scale composed of variables from the multivariate logistic analysis that showed a higher c-statistic value (0.761) than the CHADS2 and CHA2DS2-VASc scores for the prediction of LAT/SEC.
Conclusion:
In our cohort, we found two variables not included in the CHA2DS2-VASc score (renal dysfunction, left atrial enlargement) were independent predictors of LAT/SEC. A new scale combining clinical, echocardiographic and laboratory predictors might improve thromboembolic risk stratification. And there is a great need to carry out a new prospective and multicenter study, with a population more homogenous and including all the determinants for LAT/SEC to establish the independent degree of each variable and the applicability in clinical practice, facilitating the emergence of a new score of thromboembolic risk in patients with nonvalvular atrial fibrillation.
Related Concept Videos
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
01:30Venous Thrombosis I: Introduction
01:22Aortic Regurgitation II: Clinical Features and Diagnostic Tests
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
01:20Imaging Studies for Cardiovascular System II:Types of Echocardiography
Types of Echocardiography
Transthoracic Echocardiography (TTE)
TTE is the most common type of echocardiogram which involves placing a transducer on the patient's chest, emitting sound waves to create heart images. TTE is invaluable for evaluating the heart's size, structure, and motion, making it particularly useful for...
01:23Mitral Stenosis II: Clinical features and Diagnostic Tests