Association between Morphodynamic Variables by Transesophageal Echocardiography and CHA2DS2-Vasc Values

Abstract

Background: In atrial fibrillation (AF), the CHA 2 DS 2-VASc score calculates the risk for stroke. Di Biase classified the left atrial appendage (LAA), using magnetic resonance imaging, into 4 morphological types and correlated it with cerebrovascular events. Transesophageal echocardiography (TEE) also evaluates LAA and is a more widespread technique. Objective: To evaluate, using TEE, the possibility of characterizing LAA and to analyze its morphological aspects using the CHA 2 DS 2 VASc score. Method: A total of 247 patients were divided into three groups considering the CHA 2 DS 2-VASc score: Group 1: 0 and 1; Group 2: 2 and 3 and, Group 3: ≥ 4 points. TEE produced the echocardiographic data. LAA was classified into thrombogenic and non-thrombogenic morphologies. In the analysis of statistical tests, a significance level of 5% was adopted. Results: The average age was 50 and 16.2% presented AF. In Group 1, we observed normal variables with a lower prevalence of AF (8.7%, p < 0.001). In group 2, spontaneous contrast was detected in 26.7%, (p < 0.001), thrombus in 6.7% (p = 0.079) and flow velocity in LAA < 0.4 m/s in 22.7% (p < 0.001) of the cases. Group 3 presented the highest percentages of AF (31.8%, p < 0.001), stroke/TIA (77.3%, p < 0.001), EF < 55% (18.2%, p = 0.010) and higher prevalence of thrombogenic type LAA (72.7%, p = 0.014). A higher occurrence of stroke/TIA was observed in patients with thrombogenic LAA (25.2%) compared to the non-thrombogenic group (11.2%), (p = 0.005). Conclusions: The thrombogenic morphology of LAA identified in TEE presented a higher risk of stroke regardless of the CHA 2 DS 2 VASc score. Patients with higher scores had greater abnormalities in echocardiographic variables.

Risk Scores for Stroke Prevention in Patients with Non-Valvular Atrial Prevention: Is it Time to Put Parameters of Left Atrial Appendage Morphology and Function Into Clinical Practice?

“…Eight additional cross-sectional studies utilizing this classification for LAA morphology in 2,210 patients (6 with CT and 2 with TEE), found a significant association with non-chicken-wing morphology and stroke in 5 series [3][4][5][6][7] and no significant difference in 3 other studies. [8][9][10] In this issue of Int J Cardiovasc Sci, Linhares et al, 11 readdress the question of LAA morphology and stroke risk studying 237 patients with transesophageal echocardiography (TEE), the gold standard and most clinical utilized tool for thrombus detection in patients with LAA thrombosis/stroke risk. In this paper, the possibility of simple characterization with TEE patients with less-thrombogenic LAA anatomy (smooth internal surface and sharp angulation -"the chicken wing morphology"), was associated with less significant clinical events compared with patients with "thrombogenic non-chicken LAA morphology" (11.2% vs. 25.2% -p = 0.005).…”