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Updated: May 13, 2025
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
External validation of CLOTS-AF score in patients with atrial fibrillation undergoing transesophageal
Koray Kalenderoglu1, Mert Ilker Hayiroglu1, Lale Dinc Asarcikli1
1Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Insights
The novel CLOTS-AF score effectively predicts left atrial appendage thrombosis (LAAT) in nonvalvular atrial fibrillation (NVAF) patients. This score demonstrates superior predictive ability compared to the CHA2DS2-VASc score for identifying LAAT.
Area of Science:
- Cardiology
- Medical Diagnostics
- Thrombosis Research
Background:
- Left atrial appendage thrombosis (LAAT) is a critical complication of nonvalvular atrial fibrillation (NVAF), increasing the risk of thromboembolic events.
- Accurate prediction of LAAT is essential for managing NVAF patients and preventing adverse outcomes.
Purpose of the Study:
- To evaluate the predictive performance of the novel CLOTS-AF score for identifying LAAT in NVAF patients.
- To compare the effectiveness of the CLOTS-AF score against the established CHA2DS2-VASc score in predicting LAAT.
Main Methods:
- A retrospective analysis of 668 NVAF patients who underwent transesophageal echocardiography (TEE).
- Patients were classified based on the presence or absence of LAAT detected by TEE.
- The CLOTS-AF score and CHA2DS2-VASc score were calculated for all participants.
Main Results:
- Thrombus was identified in 17% of the study cohort.
- Both CLOTS-AF and CHA2DS2-VASc scores were significantly higher in patients with LAAT (p < .001).
- The CLOTS-AF score demonstrated superior predictive accuracy for LAAT compared to the CHA2DS2-VASc score (AUC: 0.70 vs. 0.61, p < .001).
Conclusions:
- The CLOTS-AF score is a validated and significant predictor of LAAT in NVAF patients.
- This scoring system shows promise for enhancing clinical decision-making in managing NVAF.
- Further validation in external cohorts is recommended to underscore its clinical utility.
Background:
Predicting thromboembolic events caused by left atrial appendage thrombosis (LAAT) is crucial since it is the most concerning complication of nonvalvular atrial fibrillation (NVAF).
Objective:
The objective of this study was to establish the predictive effectiveness of a novel scoring system known as the CLOTS-AF score in identifying the existence of thrombus using transesophageal echocardiography (TEE) in patients with NVAF and to compare it with the CHA2DS2-VASc score.
Methods:
This study was conducted retrospectively with 668 NVAF patients who underwent TEE in a single centre. The patients were categorized into two categories based on the presence or absence of LAAT on TEE. The CLOTS-AF score was computed for all patients, which was then compared to the CHA2DS2-VASc score.
Results:
Thrombus was detected in the left atrial appendage (LAA) of 114 (17%) individuals. The study revealed that the thrombus (+) group had substantially higher CHA2DS2-VASc scores and CLOTS-AF scores (3 (2-4); 4 (3-6), p < .001), respectively. Furthermore, the CLOTS-AF score was shown to be a better predictor of LAAT than the CHA2DS2-VASc score (AUC: 0.70 vs. AUC: 0.61, p < .001).
Conclusions:
This study could validate the CLOTS-AF score in an external cohort by demonstrating its significant predictive power and underscoring its vital role in clinical practice.
