Open Journal Systems

Comparison of different thromboembolism risk scores with the predictive value of left atrial thrombosis and/or spontaneous ultrasound in patients with non-valvular atrial fibrillation

Zhaodi Tan, Boshui Huang, Ying Chen, Tao Wu, Qian Chen, Deng Feng, Shuxian Zhou

Article ID: 1903
Vol 2, Issue 2, 2021

DOI: https://doi.org/10.54517/ccr.v2i2.1903
VIEWS - 30 (Abstract)

Abstract

Objective: To compare the predictive value of CHADS2, CHA2DS2-VASc, ATRIA and R2-CHADS2 scores and left atrial thrombosis and/or spontaneous ultrasound in patients with non-valvular atrial fibrillation (AF) Methods patients with non-valvular atrial fibrillation who were hospitalized in the Department of Cardiology of Sun Yat Sen Memorial. Results: 564 patients were included. The age of patients was (61.1 ± 10.1) years old, of which 63.3% were men. Hypertension was the most common complication, which was found in 49.6% of patients. Patients were divided into thrombus group (n = 82) and non-thrombus group (n = 482) according to the presence of left atrial thrombus and/or spontaneous ultrasound development CHADS2 score in thrombotic group (1[0,2]) was higher than that in non-thrombotic group (1[0,1]) (P < 0.05), and CHA2DS2-VASc score in thrombotic group (2[1,3]) was higher than that in non-thrombotic group (2[1,2]) (P < 0.05) 11.06%, 13.39%, 26.58%, 18.52% and 16.67% of patients with CHADS2 score of 0, 1, 2, 3 and 4 had left atrial thrombus and/or spontaneous ultrasound (P fortrend = 0.016), and 11.06%, 13.39% and 23.68% of patients with low, medium and high risk had left atrial thrombus and/or spontaneous ultrasound (P fortrend = 0.004); 10.81%, 10.19%, 16.57%, 21.05%, 21.05%, 16.67%, 14.29% of patients with CHA2DS2-VASc score of 0, 1, 2, 3, 4, 5, 6 or above had left atrial thrombosis and/or spontaneous ultrasound development (P fortrend = 0.019), and 8.75%, 13.90% and 19.35% of patients with low, medium and high risk had left atrial thrombosis and/or spontaneous ultrasound development (P fortrend = 0.004); The area under the ROC curve of ATRIA score and R2-CHADS2 score was 0.562. The samples based on this study had no statistical significance in the diagnosis of left atrial thrombosis and/or spontaneous ultrasound (P>0.05). Conclusion: CHADS2 score and CHA2DS2-VASc score have considerable and limited diagnostic value for left atrial thrombosis and/or spontaneous ultrasound in patients with non-valvular atrial fibrillation.

Keywords

cardiology; non valvular atrial fibrillation; transesophageal echocardiography; left atrial thrombus and/or spontaneous ultrasound development; thromboembolism risk score

Full Text:

PDF

References

1. Minno MN, Ambrosino P, DelloRussoA, et al Prev-alence of lett atrial thrombus in patients with non-valvular atrial fibrillation. A systematic review and meta-analysis of the literature. Thromb I Iae-most 2016; 115(3): 663.

2. Lowe BS, Kusunose K, Motoki I, et al. Prognostic significance of lett atrial appendage sludge in pa-tients with atrial Iibrillation: A new transesophageal echocardiographic thromboembolic risk factor. J Am Soc Echocardiogr 2014; 27(11): 1176

3. Bernhardt P, Schmidt I, Hammerstingl C, et al.Patients with atrial fibrillation and dense spon-taneous echo contrast at high risk a prospective and serial follow-up over 12 months with transesopha-geal echocardiography and cerebral magnetic res-onance imaging. J Am Coll Cardiol 2005; 45(11): 1807.

4. Kim YG, Shim J, Oh SK, et al. Risk factors for is-chemic stroke in atrial fibrillation patients under-going radiofrequency catheter ablation. Sci Rep 2019; 9(1): 7051

5. Fatkin D, Kelly R, Feneley M. Relations between lett atrial appendage blood flow velocity, spontaneous echocardiographic contrast and thromboembolic risk in vivo. J Am Coll Cardiol 1994; 23(4): 961.

6. Gage BF, Waterman AD, Shannon W, et al. Validation of clinical classification schemes for predicting stroke: results from the national registry of atrial fi-brillation. JAMA 2001; 285: 2864.

7. Lip GY, Nieuwlaat R, Pisters R, et al. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: The Euro heart survey on atrial fibrillation. Chest 2010; 137(2): 263.

8. Piccini JP, Stevens SR, Chang Y, et al. Renal dys-function as a predictor of stroke and systemic em-bolism in patients with nonvalvular atrial fibrilla-tion: validation of the R(2)CIIADS(2) index m the ROCKET AF (Rivaroxaban Once-daily, oral, direct factor Xa inhibition Compared with vitamin K an-tagonism for prevention of stroke and Embolism Trial n Atrial Fibrillation) and ATRIA (Anticoagu-lation and Risk factors In Atrial fibrillation) study cohorts. Circulation 2013; 127(2): 224.

9. Singer DE, Chang Y, Borowsky LII, et al. A new risk scheme to predict ischemic stroke and other thromboembolism in atrial fibrillation: the ATRIA study stroke risk score. J Am Heart Assoc 2013; 2(3): e000250

10. Huang Congxin, Zhang Shu, Huang Dejia, etc. Atrial fibrillation: current understanding and treatment recommendations-2018. Chinese Journal of Cardiac Pacing and Electrophysiology, 2018, 32(4): 315

11. Willens HJ, Gomez-Marin O, Nelson K, et al. Cor-relation of CIIADS2 and CIIA2DS2-VASC scores with transesophageal echocardiography risk factors for thromboembolism n a multiethnic United States population with nonvalvular atrial fibrillation. J Am Soc Echocardiogr 2013; 26(2): 175.

12. Guo Y, Apostolakis S, Blann AD, et al. Validation of contemporary stroke and bleeding risk stratification scores in non-anti- coagulated Chinese patients with atrial fibrillation. Int J Cardiol, 2013, 168(2): 904

13. 13Yasuhiro Hi, Ilisashi O, Kensuke T, et al. Lett atrial enlargement is an independent predictor of stroke and systemic embolism in patients with non-valvular atrial Iibrillation. Scientific Reports 2016; 6: 1038.

14. 14Di Castelnuovo A, Veroneri G, Costanzo S, et al. NT-pro BNP (N-terminal Pro-B-type natriuretic peptide) and the risk of stroke. Stroke 2019; 50(3): 610.

15. Пе II, Guo J, Zhang A. The value of urine albumin in predicting thromboembolic events for patients with non-valvular atrial fibrillation. Int J Cardiol 2016; 22(1): 827.

16. Li Qi, Liao Jn, Kong B, et al. The relationship be-tween left atrial appendage parameters on transesophageal ultrasound and left atrial append-age thrombus and/or spontaneous imaging in pa-tients with atrial fibrillation. Chinese Journal of Cardiac Pacing and Electrophysiology 2017; 31(2):131.

17. 17Roldan V, Marin F, Fernandez П, et al. Renal impairment in a real-life cohort of anticoagulated patients with atrial Iibrillation (implications for thromboembolism and bleeding). Am J Cardiol 2013; 111(8): 1159

18. 18Van Staa TP, Setakis E, Di Tanna GL, et al. A comparison of risk stratification schemes for strokein 79, 884 atrial fibrillation patients in gen-eralpractice. J Thromb Haemost 2011; 9(1): 39.

19. Tsadok MA, Senderey AB, Reges O, etal. Compar-ison of stroke risk stratification scores for atrial fi-brillation. Am J Cardiol 2019; 123(11): 1828.