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Updated: Jan 8, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
A new risk-stratified scoring system for predicting left atrial appendage thrombus in patients with nonvalvular
Junhao Liu1, Xuefeng Zhu2, Xiaobo Zheng3
1School of Clinical Medicine, Shandong Second Medical University, Baotong West Street, Weicheng District, Weifang City, Shandong, 261053, China.
Insights
The CHA2DS2-VASc score has limitations in predicting left atrial appendage thrombus (LAAT) in nonvalvular atrial fibrillation (NVAF) patients. A new LEFT-AF score, incorporating factors like left atrial diameter and heart failure history, shows improved risk stratification for LAAT.
Area of Science:
- Cardiology
- Medical Diagnostics
- Thrombosis Research
Background:
- The CHA2DS2-VASc score has demonstrated limitations in accurately predicting left atrial appendage thrombus (LAAT) in patients with nonvalvular atrial fibrillation (NVAF).
- Accurate risk stratification for LAAT is crucial for guiding anticoagulation therapy and preventing thromboembolic events in NVAF patients.
Purpose of the Study:
- To identify novel predictors of LAAT in NVAF patients.
- To develop and validate a more precise risk-assessment model for LAAT compared to existing scores.
Main Methods:
- A cohort of 1505 NVAF patients without prior anticoagulation underwent transesophageal echocardiography between January 2019 and December 2023.
- Clinical, biomarker, and echocardiographic data were collected. A derivation cohort from one center and a validation cohort from another were used.
- The LEFT-AF risk model was developed using parameters including left atrial diameter (LAD), left ventricular ejection fraction (LVEF), history of heart failure (HF), history of stroke, and non-paroxysmal AF (NPAF).
Main Results:
- LAAT was detected in 7.24% of the 1505 analyzed patients.
- The LEFT-AF score demonstrated superior discriminative performance (AUC 0.855) compared to CHA2DS2-VASc, CHA2DS2, and CLOTS-AF scores in both derivation and validation cohorts.
- Key predictors identified for LAAT included LAD, LVEF, HF history, stroke history, and NPAF.
Conclusions:
- The prevalence of LAAT in this NVAF cohort was 7.24%, highlighting the need for improved risk assessment.
- The LEFT-AF score offers enhanced risk stratification for LAAT, particularly beneficial for patients with low CHA2DS2-VASc scores.
- This novel scoring system may aid in optimizing anticoagulation decisions for NVAF patients at risk of LAAT.
Background:
The predictive capacity of the CHA2DS2-VASc score for left atrial appendage thrombus (LAAT) detection in nonvalvular atrial fibrillation (NVAF) patients shows significant limitations.
Objective:
To recognize predictors of LAAT and create a more precise risk-assessment model.
Methods:
Between January 2019 and December 2023, consecutive NVAF patients without a previous history of anticoagulation who underwent transesophageal echocardiography were recruited from two centers. Clinical data, biomarker information, and transthoracic echocardiographic parameters were collected in a standardized manner. The derivation cohort comprised patients from one center, while the validation cohort consisted of participants from the other center.
Results:
1505 patients (mean age 63.4±9.77 years; 895 male) were analyzed. LAAT was detected in 109 (7.24%) of the total 1505 patients. The final parameters selected for the LEFT-AF risk model included left atrial diameter (LAD), left ventricular ejection fraction (LVEF), history of heart failure (HF), history of stroke, and non-paroxysmal AF (NPAF). In the derivation cohort, the novel scoring system demonstrated superior discriminative performance compared to the currently used CHA2DS2-VASc score (0.693, 95% CI 0.634-0.752) (P<0.001), CHA2DS2 score (0.679, 95% CI 0.621-0.731) (P<0.001) and CLOTS-AF score (Creatinine>1.5mg/dL, LVEF<50%, LAVI>34ml/m2, TAPSE<17mm, Stroke, AF rhythm) (0.762, 95% CI 0.704-0.821), with an area under the receiver operating characteristic curve (AUC) of 0.855 (95% CI 0.808-0.902) (P<0.001). This same superior performance was maintained in the validation cohort.
Conclusion:
Among patients with NVAF who had not previously received anticoagulation therapy, the prevalence of LAAT was 7.24%. The LEFT-AF score improves LAAT risk stratification, particularly in patients with low CHA2DS2-VASc scores, potentially guiding anticoagulation decisions.
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