Abstract 3026: Prediction of Left Atrial Appendage Thrombus and Severity of Left Atrium Blood Stasis by CHADS-VASc and CHADS2
BACKGROUND. Nearly half of strokes in non-valvular atrial fibrillation (NVAF) are due to non-cardioembolic mechanisms including carotid disease, lacune, watershed, venous sinus thrombosis, or hemorrhage. Tools capable of identifying those AF patients most likely to suffer a cardioembolic complication of AF would be very helpful for deciding which patients to treat with anticoagulants compared to aspirin. CHA2DS2-VASc has been advocated as an improved stroke risk assessment tool for NVAF patients.
METHODS. CHA2DS2-VASc was compared to CHADS2 for the prediction of left atrial appendage thrombus (LAAT), and association (Spearman correlation) with spontaneous echo contrast (SEC), left atrium appendage emptying velocity (LAAEV), left atrium volume index (LAVI) in consecutive NVAF patients undergoing echocardiographic study (10/1/2007 - 9/30/2009).
RESULTS. 525 NVAF patients (age 62±13 years; 25% women; 28% persistent AF and 17% permanent AF) were parsed by extent of atrial blood stasis/LAAT (Table). CHA2DS2-VASc and CHADS2 were similar for the prediction of LAAT (Figure). Measures of SEC intensity (0.416 vs 0.414;), LAAEV (-0.393 vs -0.344), and LAVI (0.322 vs 0.303) carried similarly associations with CHA2DS2-VASc and CHADS2 scores.
CONCLUSION. The challenge of stroke prevention in NVAF is balancing the risk and benefit of anticoagulant therapy. CHA2DS2-VASc does not improve the identification of patients with LAAT or low atrial mechanical function compared to CHADS2. Moreover CHA2DS2-VASc appears to overestimate the score of low risk patients for whom antiplatelet therapy would be sufficient and is more cumbersome compared to the original CHADS2.
- © 2012 by American Heart Association, Inc.