Association between CHA₂DS₂-VASc score and left atrial function by speckle-tracking echocardiography in patients with...

The CHA₂DS₂-VASc score is an established tool for thromboembolic risk assessment in atrial fibrillation. Individual components of the score may affect left atrial (LA) function. Speckle-tracking echocardiography (STE) enables detection of early, subtle changes in the LA. This study aimed to test whether LA function, as assessed by STE, differs among patients with sinus rhythm according to their CHA₂DS₂-VASc score.

This study included 150 patients with sinus rhythm. They were grouped by CHA₂DS₂-VASc score: low (1 for women, 0 for men), moderate (2 for women, 1 for men), and high (≥ 3 for women, ≥ 2 for men), with 50 patients per group. All participants gave written consent, provided medical histories, underwent a 12-lead electrocardiogram, and received standard echocardiography and STE.

The high-risk group had significantly lower LA reservoir strain (LASr) and LA conduit strain (LAScd) compared to the moderate- and low-risk groups (high vs. moderate vs. low: LASr, 33.2 ± 7.1 vs. 36.9 ± 6.1 vs. 40.6 ± 5.6; LAScd, 20.3 ± 5.7 vs. 23.5 ± 4.8 vs. 26.9 ± 3.9), with all P-values of < 0.01. Moderate-risk patients also showed lower strain values than low-risk patients. In contrast, LA maximal volume index did not differ among the groups (P = 0.536). Mediation analysis showed that the association between the score and LAScd was statistically mediated by left ventricular (LV) diastolic dysfunction (89.7%) with no significant direct association (P = 0.342). For LASr, 62.4% of the association was statistically mediated by LV diastolic dysfunction, with a residual direct statistical association remaining (β = -0.139, P = 0.008).

Increased CHA₂DS₂-VASc scores correlated with reduced LASr and LAScd. The association with LAScd was mainly mediated by LV diastolic dysfunction. A direct statistical association of the score was noted with LASr, indicating possible early LA pathology. Further research should assess the clinical relevance of these echocardiographic findings for risk stratification in patients with high CHA₂DS₂-VASc score.