Abstract

ALLENDE, Norberto G et al. Correlation Between CHA₂DS₂-VASc Score and Atrial Thrombus in Patients with Atrial Fibrillation Undergoing Cardioversion. Rev. argent. cardiol. [online]. 2013, vol.81, n.2, pp.144-150. ISSN 1850-3748.  http://dx.doi.org/10.7775/rac.es.v81.i2.1904.

Background Patients with atrial fibrillation represent a group of risk for thromboembolic complications, with catastrophic consequences when affecting the central nervous system. The performance of risks 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 throm-boembolic 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 of the medical history of patients with atrial fibrillation of unknown duration or lasting >48 hours, undergoing transesophageal echocardiography before scheduled electrical cardioversion was conducted. The correlation of the components of the CHA₂DS₂-VASc scores and of the total score with 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%) 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.

Keywords : Atrial Fibrillation; Transesophageal Echocardiography; Thrombus; Thromboembolism; Cardioversion; Anticoagulants; Ventricular Function.