Correlation Between CHA2DS2-VASc Score and Atrial Thrombus in Patients with Atrial Fibrillation Undergoing Cardioversion

Norberto G. Allende, Elio D. Barrera, Carlos Rodríguez Pagani, Eduardo Carrasco, Gerardo Marambio, Guillermo López Soutric, Federico Cintora, Fanny Calvo, Ricardo Pérez de la Hoz

Abstract


Background Patients with atrial fibrillation represent a group of risk for thromboembolic complications, with catastrophic consequences when they affect the central nervous system. The performance of risk scores to predict clinical events has been evaluated by several publications; yet, its correlation with the presence of thrombi in the left atrium or left atrial appendage has been poorly investigated. The use of the CHA2DS2-VASc score has been recently proposed for stratification of thromboembolic risk. Objective To evaluate the prevalence of left atrial thrombus and its correlation with the components of the CHA2DS2-VASc score and with left ventricular systolic function in patients scheduled for electrical cardioversion. Methods A prospective registry was conducted of the medical history of patients with atrial fibrillation of unknown duration or lasting > 48 hours, undergoing transesophageal echocardiography before scheduled electrical cardioversion. The correlation between the CHA2DS2-VASc score variables and the total score to predict the presence of thrombi in transesophageal echocardiography was analyzed. The result of the sum of the CHA2DS2-VASc score plus a score of left ventricular systolic function (normal = 0, mild dysfunction = 1, moderate dysfunction = 2, severe dysfunction = 3) was also evaluated. Results A total of 129 patients (mean age 70 ± 12 years) were included; 21 (16%) of which had thrombus. This finding was more prevalent in patients with risk factors, but was only statistically significant for heart failure and diabetes. The risk of thrombus in the LA/LAA progressively increased at higher CHA2DS2-VASc (3.6 ± 1.6 with thrombus vs. 2.7 ± 1 without thrombus; p = 0.024, area under the ROC curve = 0.65). This association was greater when left ventricular systolic function was included (p = 0.006, area under the ROC curve = 0.69). A CHA2DS2-VASc < 2 did not warrant the absence of thrombi.Conclusions The CHA2DS2-VASc score, developed to predict the risk of thromboembolic events is also associated with the presence of thrombus in patients with atrial fibrillation of unknown duration. The addition of left ventricular systolic function to the total score might improve its predictive ability.

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Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020 www.sac.org.ar revista@sac.org.ar