Prediction of left atrial thrombus in patients with nonvalvular atrial fibrillation referred to catheter ablation or cardioversion: comparison of different risk scores

Abstract

Funding Acknowledgements Type of funding sources: None. Background. Left atrial thrombus (LAT) is the main source of cardiac emboly in patients with non-valvular atrial fibrillation (NAF). Several risk scores – mostly modified CHADS2 and CHA2DS2-VASc – were offered to predict LAT in patients with NAF. However, their relative predictive value requires further evaluation. Purpose. Compare the ability of different risk scores to predict LAT before catheter ablation or cardioversion in patients with NAF. Methods. In a retrospective single-center study, medical records of 1994 patients with NAF who underwent transesophageal echocardiography before catheter ablation or cardioversion were analyzed. LAT was identified in 33 (1.6%) of them. For the control group 167 patients without LAT were randomly selected from this database. Logistic regression analysis and C-statistic were used for evaluation and comparison of predictive values of CHADS2, R2CHADS2, CHA2DS2-VASc, R-CHA2DS2-VASc, R2CHA2DS2-VASc, CHA2DS2-VASc-RAF, mCHA2DS2-VASc and CHA2DS2-VASc-AFR scores. Results. The mean age of studied patients was 60.3 ± 10.9 years, 110 (55%) of them were males. The mean CHA2DS2-VASc score was 2.54 ± 1.79. Results of univariate analysis and C-statistic for above mentioned risk scores are presented in the table. Each of them was associated with LAT. In comparison with a CHA2DS2-VASc score C-statistic was significantly higher for CHA2DS2-VASc-RAF and CHA2DS2-VASc-AFR scores (p values 0.03 and 0.001 respectively). In multivariate analysis only CHA2DS2-VASc-RAF score was associated with LAT (OR 1.37; 95% CI 1.21-1.55, p < 0.0001). OR for LАT in patients with CHA2DS2-VASc-RAF >3 was 12.8 (95% CI 3.75-43.9; p < 0.0001) with sensitivity, specificity, positive and negative predictive values 90.6%, 57.1%, 33.3% and 58.9% respectively. Conclusion. In a group of patients with NAF and relatively low incidence of LAT all studied scores were associated with LAT and CHA2DS2-VASc-RAF score has appeared the most informative. Predictors of LAT in patients with NAF Risk stratification models OR (95% CI) p-value C-statistic (95% CI) CHADS2 2.12 (1.55-2.91) <0.0001 0.77 (0.68-0.85) R2CHADS2 2.00 (1.53-2.62) <0.0001 0.78 (0.69-0.87) CHA2DS2-VASc 1.65 (1.36-2.05) <0.0001 0.74 (0.65-0.84) R-CHA2DS2-VASc 1.64 (1.34-2.03) <0.0001 0.76 (0.66-0.85) R2CHA2DS2-VASc 1.59 (1.32-1.92) <0.0001 0.76 (0.66-0.85) CHA2DS2-VASc- RAF 1.35 (1.27-1.52) <0.0001 0.84 (0.76-0.91) mCHA2DS2-VASc 1.83 (1.42-2.35) <0.0001 0.75 (0.65-0.85) CHA2DS2-VASc-AFR 1.75 (1.41-2.17) <0.0001 0.80 (0.71-0.88)

Differences in the predictors of left atrial appendage thrombus between men and women treated with dabigatran or rivaroxaban

“…The CHADS2 and CHA2DS2-VASc scores are used for the assessment of thromboembolic risk in patients with nonvalvular AF. The CHA2DS2-VASc-RAF score additionally included the type of AF and renal dysfunction as LAAT predictors, which appeared to improve thromboembolic risk stratification [2][3][4]. Despite optimal treatment with vitamin K antagonists and the currently preferred non-vitamin K oral antagonists (NOACs), LAAT still develops in 2% to 10% of patients on anticoagulant treatment [5][6][7][8].…”