非弁膜症性心房細動患者における左心耳血栓症を予測するための新しいリスク層別スコアリングシステム

The predictive capacity of the CHA2DS2-VASc score for left atrial appendage thrombus (LAAT) detection in nonvalvular atrial fibrillation (NVAF) patients shows significant limitations.

To recognize predictors of LAAT and create a more precise risk-assessment model.

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.

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.

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.