Efficacy of the CHADS2 Scoring System to Assess Left Atrial Thrombogenic Milieu Risk Before Cardioversion of Non-Valvular Atrial Fibrillation

Yarmohammadi, Hirad; Klosterman, Tristan; Grewal, Gaganpreet; Alraies, M. Chadi; Varr, Brandon C.; Lindsay, Bruce D.; Zurick, Andrew O.; Shrestha, Kevin; Tang, W.H. Wilson; Bhargava, Mandeep; Klein, Allan L.

doi:10.1016/j.amjcard.2013.04.047

Cited by 29 publications

(24 citation statements)

References 27 publications

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“…As shown in our study and previous studies with large sample size [21, 26], NVAF patients may have a risk of LAT despite a low CHADS 2 /CHA 2 DS 2 -VASc score. It is unreasonable to consider TEE not necessary in NVAF patients with a CHADS 2 /CHA 2 DS 2 -VASc score of 0 before ablation or cardioversion.…”

Section: Discussionsupporting

confidence: 80%

Association of CHADS₂and CHA₂DS₂-VASc Scores with Left Atrial Thrombus with Nonvalvular Atrial Fibrillation: A Single Center Based Retrospective Study in a Cohort of 2695 Chinese Subjects

Huang

Xue

et al. 2017

BioMed Research International

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The main mechanism of the CHADS2 and CHA2DS2-VASc scores to predict stroke in nonvalvular atrial fibrillation (NVAF) is still controversial. We evaluated the association of the CHADS2 and CHA2DS2-VASc scores with left atrial thrombus (LAT) as detected by transesophageal echocardiographic (TEE) and compared the predictive ability of these risk stratification schemes with nonvalvular atrial fibrillation (NVAF). Data from 2,695 consecutive NVAF patients in whom TEE was performed for screening LAT from July 2007 to February 2014 were analyzed. Only 3% of the subjects had LAT. Presence of LAT was not significantly associated with either CHADS2 (P = 0.07) or CHA2DS2-VASc score (P = 0.12). The area under the curve (AUC) concerning LAT prediction using CHADS2 and CHA2DS2-VASc was 0.574 and 0.569, respectively. A composition model includes previous stroke or transient ischemic attack, nonparoxysmal AF, moderate to severe left ventricular systolic dysfunction, left atrial enlargement, and cardiomyopathy which improved the discrimination significantly (AUC = 0.743). In our cohort, both CHADS2 and CHA2DS2-VASc scores were of limited value for predicting LAT in patients with NVAF. This questions the CHADS2/CHA2DS2-VASc score predicting stroke mainly through the mechanism of cardiogenic embolism. A scoring scheme combining clinical and echocardiographic parameters may better predict LAT as a surrogate for cardioembolic risk in NVAF patients.

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Section: Discussionsupporting

confidence: 80%

Association of CHADS₂and CHA₂DS₂-VASc Scores with Left Atrial Thrombus with Nonvalvular Atrial Fibrillation: A Single Center Based Retrospective Study in a Cohort of 2695 Chinese Subjects

Huang

Xue

et al. 2017

BioMed Research International

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“…On the other hand, LA thrombus prevalence was reported to be 3% in the above‐mentioned German study when TEE was performed in 295 low‐risk patients with AF with a CHADS 2 score of 0 or 1 [9]. LA thrombus prevalence or sludge increases with increasing scores of CHADS 2 and CHA 2 DS 2 ‐VASc [10,11]. Therefore, it was not surprising that in our survey, patients with LA thrombus tended to be older and had a higher CHADS 2 score and prevalence of previous stroke or transient ischemic attack than those without demonstrable LA thrombus.…”

Section: Discussionmentioning

confidence: 61%

Left atrial thrombus formation and resolution during dabigatran therapy: A Japanese Heart Rhythm Society report

Mitamura

Nagai

Watanabe

et al. 2015

Journal of Arrhythmia

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“…Recently, some researches have shown that CHADS2 and CHA2DS2-VASc scores not only predict stroke risk, but also have an obvious relationship with LAT and can be used to predict the formation of LAT. [3][4][5][6] However, Yarmohammadi, et al 4) found that patients with a score of 0 or 1 point in CHADS2 accounted for almost a third of the total with atrial thrombus. In addition, a prospective study including 295 NVAF patients with 0 or 1 point CHADS2 score were followed up, onaverage for 5 years.…”

Section: Discussionmentioning

confidence: 99%

The Refinement of Risk Stratification for Atrial Thrombus or Spontaneous Echo Contrast in Nonvalvular Atrial Fibrillation

Ning

et al. 2017

Int. Heart J.

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SummaryAs for nonvalvular atrial fibrillation (NVAF) patients with left atrial thrombus or spontaneous echo contrast (LAT/SEC), we evaluated the additional predictive value of serum uric acid (SUA) and Left atrial diameter (LAD) for CHADS2 and CHA2DS2-VASc, and explored the influence from the level of SUA and LAD to LAT/ SEC in moderate risk group. Thus, we put forward the concept of a borderline high risk group to guide clinical anticoagulant therapy in patients with NVAF.A total of 284 NVAF patients without the history of anticoagulant prior to hospitalization were enrolled. They were divided into LAT/SEC group or No LAT/SEC group according to transesophageal echocardiography (TEE). Then, we explored and compared the additional predictive value of serological and ultrasonic indexes after combining them to CHADS2/CHA2DS2-VASc.61 patients (21.48%) had LAT/SEC. SUA and LAD were the independent risk factors of LAT/SEC. After being added with LAD and SUA, the predictive value of CHADS2 and CHA2DS2-VASc were increased much more than others. In the moderate risk group, the incidence of LAT/SEC rose significantly when SUA or LAD was higher than cut-off values.SUA and LAD enhanced the predictive ability of CHADS2 and CHA2DS2-VASc for LAT/SEC as additional factors. For patients in moderate risk group, if SUA or LAD was higher than cut-off values, the risk of thromboembolism events would rise accompanied by the elevated risk of LAT/SEC.(Int Heart J 2017; 58: 885-893) Key words: Predictive value, Left atrial thrombus, Borderline high risk group A trial fibrillation (AF) is the most common arrhythmia, affecting approximately 8 million patients in China.1) Meanwhile, its morbidity is increasing with the aging population as well as the morbidity of cardiovascular disease year by year. Cardiac stroke accounted for about a quarter of all patients with stroke, and more than half of them were caused by AF.2) AF increased the risk of stroke by five times. Among them, more than 90% of embolism comes from left atrial appendage (LAA). Therefore, preventing thrombus in LAA can reduce the morbidity of stroke, and it can be used as a substitute to prevent patients with AF from stroke in earlier stage.At present, CHADS2 scores and CHA2DS2-VASc scores are widely accepted and practical clinical stroke risk stratifications. Recently, some researches have shown that CHADS2 and CHA2DS2-VASc scores not only predict stroke risk, but also have an obvious relationship with LAT and can be used to predict the formation of LAT. [3][4][5][6] However, Yarmohammadi, et al. 4) found that patients with a score of 0 or 1 point in CHADS2 accounted for almost a third of the total with atrial thrombus. In addition, a prospective study including 295 NVAF patients with 0 or 1 point CHADS2 score were followed up, onaverage for 5 years. The results showed that 3% of the patients had LAT and 8% of patients had SEC. 7) By adding some additional risk factors to CHADS2 and CHA2DS2-VASc score, especially in patients who should have anticoagulant therapy but were i...

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Efficacy of the CHADS2 Scoring System to Assess Left Atrial Thrombogenic Milieu Risk Before Cardioversion of Non-Valvular Atrial Fibrillation

Cited by 29 publications

References 27 publications

Association of CHADS₂and CHA₂DS₂-VASc Scores with Left Atrial Thrombus with Nonvalvular Atrial Fibrillation: A Single Center Based Retrospective Study in a Cohort of 2695 Chinese Subjects

Association of CHADS₂and CHA₂DS₂-VASc Scores with Left Atrial Thrombus with Nonvalvular Atrial Fibrillation: A Single Center Based Retrospective Study in a Cohort of 2695 Chinese Subjects

Left atrial thrombus formation and resolution during dabigatran therapy: A Japanese Heart Rhythm Society report

The Refinement of Risk Stratification for Atrial Thrombus or Spontaneous Echo Contrast in Nonvalvular Atrial Fibrillation

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Efficacy of the CHADS2 Scoring System to Assess Left Atrial Thrombogenic Milieu Risk Before Cardioversion of Non-Valvular Atrial Fibrillation

Cited by 29 publications

References 27 publications

Association of CHADS2and CHA2DS2-VASc Scores with Left Atrial Thrombus with Nonvalvular Atrial Fibrillation: A Single Center Based Retrospective Study in a Cohort of 2695 Chinese Subjects

Association of CHADS2and CHA2DS2-VASc Scores with Left Atrial Thrombus with Nonvalvular Atrial Fibrillation: A Single Center Based Retrospective Study in a Cohort of 2695 Chinese Subjects

Left atrial thrombus formation and resolution during dabigatran therapy: A Japanese Heart Rhythm Society report

The Refinement of Risk Stratification for Atrial Thrombus or Spontaneous Echo Contrast in Nonvalvular Atrial Fibrillation

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Association of CHADS₂and CHA₂DS₂-VASc Scores with Left Atrial Thrombus with Nonvalvular Atrial Fibrillation: A Single Center Based Retrospective Study in a Cohort of 2695 Chinese Subjects

Association of CHADS₂and CHA₂DS₂-VASc Scores with Left Atrial Thrombus with Nonvalvular Atrial Fibrillation: A Single Center Based Retrospective Study in a Cohort of 2695 Chinese Subjects