Role of CHADS2 Score in Evaluation of Thromboembolic Risk and Mortality in Patients With Atrial Fibrillation Undergoing Direct Current Cardioversion (from the ACUTE Trial Substudy)

Association of Thromboembolic Risk Score with Left Atrial Thrombus and Spontaneous Echocardiographic Contrast in Non-Anticoagulated Nonvalvular Atrial Fibrillation Patients

“…However, it is still controversial whether the CHADS2/ CHA2DS2-VASc score is an independent risk factor for LAT/SEC. Several studies showed the score was not an independent risk factor for LAT/SEC [11,19,22], and had a modest value for predicting LAT/SEC in most studies [12,20,22,23]. These discrepancies might be due to the following reasons: (1) the development of LAT/SEC is closely associated with the matrix and function of the left atrium [24,25], which has different associations with the components of the CHADS2/CHA2DS2-VASc score.…”

“…Some previous studies reported an increase in the incidence of LAT/SEC as the CHADS2/CHA2DS2-VASc score increases [10,11,[18][19][20][21], which might be due to the number of comorbidities, that is, the greater the number of comorbidities, the higher the risk of LA dysfunction. However, it is still controversial whether the CHADS2/ CHA2DS2-VASc score is an independent risk factor for LAT/SEC.…”

“…Therefore, a potential risk stratification model for LAT/SEC may provide potentially useful prediction scheme for cardioembolic stroke risk. Previous studies examining the risk factors of LAT/SEC mostly included AF patients who had received anticoagulation treatment [9][10][11][12], making the interpretation of the results problematic. In China, unlike other settings in the west, most AF patients did not receive anticoagulation therapy before catheter ablation and they were usually referred to screen for thrombosis using preprocedural transesophageal echocardiography (TEE).…”

Management of anticoagulation in rate controlled atrial fibrillation: A three-step approach

“…Furthermore, according to the Assessment of Cardioversion Using Transesophageal Echocardiography (ACUTE) trial sub study, the CHA 2 DS 2 -VASc score was found to be more reliable in predicting left atrial appendage thrombus formation, especially in those with a low or intermediate risk score (23).…”

Sluggish Left Atria Predecessor to Stroke in CKD: Cause or Effect?

“…Diagnostic tests such as transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) are usually ordered in the setting of embolic stroke and atrial fibrillation to assess for the presence of left atrial appendage thrombus (LAAT) which needs to be isolated, removed or dissolved prior to cardioversion [4]. Patients who do not have LAAT might still be at a higher risk for stroke, based on their CHADS 2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus and stroke) [5] and CHA 2 DS 2 -VASc (age 65–74 years, history of vascular disease and female gender along with the clinical variables of CHADS 2 ) from other mechanisms such as low-flow states or states of hypercoagulability. …”