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Published on: February 26, 2013
Association of MAPH and CHA₂DS₂-VASc Scores with Left Atrial Thrombus in Atrial Fibrillation Patients Undergoing
Hasan Can Konte1, Emir Derviş1, Ömer Alyan1
1Department of Cardiology, Istanbul Medipol University, Istanbul, Türkiye.
Insights
The MAPH score, considering mean platelet volume, age, persistent atrial fibrillation, and hematocrit, is better than the CHA₂DS₂-VASc score at detecting left atrial thrombus in atrial fibrillation patients. This finding aids in pre-ablation risk assessment.
Area of Science:
- Cardiology
- Medical Diagnostics
- Thrombosis Research
Background:
- Left atrial (LA) thrombus is a significant risk in patients with atrial fibrillation (AF).
- Accurate risk stratification is crucial for guiding treatment and preventing thromboembolic events before AF ablation.
- Existing scoring systems may not fully capture the risk of LA thrombus.
Purpose of the Study:
- To compare the efficacy of the Mean platelet volume-Age-Persistent atrial fibrillation-Hematocrit (MAPH) score against the CHA₂DS₂-VASc score in predicting the presence of LA thrombus.
- To evaluate the diagnostic performance of these scores in patients with AF undergoing pre-procedural assessment.
Main Methods:
- A retrospective cross-sectional study of 258 AF patients undergoing transesophageal echocardiography (TEE).
- Patients were assessed for the presence or absence of LA thrombus.
- The MAPH and CHA₂DS₂-VASc scores were calculated and compared for their association with LA thrombus.
Main Results:
- The median MAPH score was significantly higher in patients with LA thrombus (p < 0.001).
- Ongoing AF, anticoagulant therapy, elevated albumin, C-reactive protein (CRP), and international normalized ratio (INR) were independently associated with thrombus presence.
- The MAPH score showed superior discriminative performance compared to the CHA₂DS₂-VASc score (p = 0.014).
Conclusions:
- The MAPH score is significantly associated with the presence of LA thrombus in AF patients.
- The MAPH score demonstrates superior ability in discriminating LA thrombus compared to the CHA₂DS₂-VASc score.
- The MAPH score may be a valuable tool for identifying LA thrombus during pre-procedural evaluations for AF ablation.
Objective:
This study aimed to compare the association of the MAPH score (Mean platelet volume-Age-Persistent atrial fibrillation-Hematocrit) and the CHA₂DS₂-VASc score (Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes mellitus, prior Stroke/transient ischemic attack (2 points), Vascular disease, Age 65-74 years, and Sex category (female)) with the presence of left atrial thrombus in patients undergoing atrial fibrillation ablation.
Method:
This retrospective cross-sectional study included 258 consecutive patients with atrial fibrillation (AF) who underwent transesophageal echocardiography to assess thrombus status prior to ablation. Based on these findings, patients were categorized according to the presence or absence of left atrial (LA) thrombus.
Results:
The mean age of the study population was 55.2 +- 11.7 years, and 53.5% of the participants were female. Patients with LA thrombus were more likely to have ongoing AF during TEE, mild mitral stenosis, elevated C-reactive protein (CRP) and international normalized ratio (INR) levels, and reduced ejection fraction. The median MAPH score was significantly higher in the thrombus group (p < 0.001). In multivariable analysis, ongoing AF (odds ratio [OR]: 3.83), anticoagulant therapy (OR: 14.95), elevated albumin (OR: 1328.5), elevated CRP (OR: 1.38), and elevated INR (OR: 9.09) were independently associated with thrombus presence. The MAPH score demonstrated superior discriminative performance compared to the CHA₂DS₂-VASc score for identifying LA thrombus (p = 0.014).
Conclusion:
The MAPH score was significantly associated with LA thrombus and demonstrated superior discriminative ability compared to the CHA₂DS₂-VASc score for detecting LA thrombus. These findings suggest that the MAPH score may serve as a useful marker for identifying existing LA thrombus in patients with AF undergoing pre-procedural evaluation.
