Improvement of predictive value for thromboembolic risk by incorporating left atrial functional parameters in the CHADS2 and CHA2DS2-VASc scores

Mi Na Kim, Su A. Kim, Jongil Choi, Seong-Mi Park, Sang Won Park, Young Hoon Kim, Wan Joo Shim

Research output: Contribution to journalArticle

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Abstract

The discriminative ability of the widely used CHADS2 and CHA2DS2-VASc scores for risk stratification of thromboembolism in atrial fibrillation (AF) is known as modest. Some echocardiographic parameters are known risk factors for thromboembolism. This study aimed to evaluate whether combining echocardiographic parameters with CHADS2 and CHA2DS2-VASc scores can improve the predictive power for embolic risk in AF. A total of 526 (F/M = 83/433, mean age = 57.6 } 10.7 years) patients with non-valvular AF were enrolled. The predictability for left atrial (LA) thrombus or dense spontaneous echo contrast (SEC) using clinical scores or echocardiographic parameters or combining clinical scores and echocardiographic parameters was calculated and compared. Dense SEC or thrombus was present in 51 patients. The predicting powers of the CHADS2 and CHADS2-VASc scores for the presence of dense SEC or thrombus were modest (c-statistics 0.65 and 0.68, respectively, 95% confidence interval [CI] 0.61-0.69 and 0.64-0.74, respectively, both P < 0.001). Impaired LA function was the most descriptive predictor for the presence of thrombus or dense SEC among echocardiographic parameters. Combining impaired LA function (LA emptying fraction < 30%) with the CHADS2 and CHA2DS2-VASc scores showed the improvement of predictive power in detecting dense SEC or thrombus (c-statistics 0.78 and 95% CI 0.74-0.81 and c-statistics 0.77 and 95% CI 0.73-0.81, respectively, both P < 0.001). Adding LA functional markers to the CHADS2 or CHA2DS2-VASc score improved the predictive value of the presence of thrombus or dense SEC. In clinical situations, anticoagulation should be considered to prevent embolism in patients with low-risk scores when they have LA dysfunction. (Int Heart J 2015; 56: 286-292)

Original languageEnglish
Pages (from-to)278-285
Number of pages8
JournalInternational Heart Journal
Volume56
Issue number3
Publication statusPublished - 2015 Jan 1

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Thrombosis
Left Atrial Function
Atrial Fibrillation
Thromboembolism
Confidence Intervals
Embolism

Keywords

  • Atrial fibrillation
  • Left atrium
  • Risk stratification
  • Thromboembolism

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Improvement of predictive value for thromboembolic risk by incorporating left atrial functional parameters in the CHADS2 and CHA2DS2-VASc scores. / Kim, Mi Na; Kim, Su A.; Choi, Jongil; Park, Seong-Mi; Park, Sang Won; Kim, Young Hoon; Shim, Wan Joo.

In: International Heart Journal, Vol. 56, No. 3, 01.01.2015, p. 278-285.

Research output: Contribution to journalArticle

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abstract = "The discriminative ability of the widely used CHADS2 and CHA2DS2-VASc scores for risk stratification of thromboembolism in atrial fibrillation (AF) is known as modest. Some echocardiographic parameters are known risk factors for thromboembolism. This study aimed to evaluate whether combining echocardiographic parameters with CHADS2 and CHA2DS2-VASc scores can improve the predictive power for embolic risk in AF. A total of 526 (F/M = 83/433, mean age = 57.6 } 10.7 years) patients with non-valvular AF were enrolled. The predictability for left atrial (LA) thrombus or dense spontaneous echo contrast (SEC) using clinical scores or echocardiographic parameters or combining clinical scores and echocardiographic parameters was calculated and compared. Dense SEC or thrombus was present in 51 patients. The predicting powers of the CHADS2 and CHADS2-VASc scores for the presence of dense SEC or thrombus were modest (c-statistics 0.65 and 0.68, respectively, 95{\%} confidence interval [CI] 0.61-0.69 and 0.64-0.74, respectively, both P < 0.001). Impaired LA function was the most descriptive predictor for the presence of thrombus or dense SEC among echocardiographic parameters. Combining impaired LA function (LA emptying fraction < 30{\%}) with the CHADS2 and CHA2DS2-VASc scores showed the improvement of predictive power in detecting dense SEC or thrombus (c-statistics 0.78 and 95{\%} CI 0.74-0.81 and c-statistics 0.77 and 95{\%} CI 0.73-0.81, respectively, both P < 0.001). Adding LA functional markers to the CHADS2 or CHA2DS2-VASc score improved the predictive value of the presence of thrombus or dense SEC. In clinical situations, anticoagulation should be considered to prevent embolism in patients with low-risk scores when they have LA dysfunction. (Int Heart J 2015; 56: 286-292)",
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