Evaluating PERFAMLI and CHA₂DS₂-VASc scoring systems in predicting left atrial thrombosis in non-valvular atrial fibrillation

This study aimed to assess the predictive performance of the PERFAMLI scoring system for identifying left atrial (LA) or left atrial appendage (LAA) thrombosis in patients with non-valvular atrial fibrillation (NVAF), and to compare its diagnostic utility with that of the CHA₂DS₂-VASc score. A retrospective, single-center study was conducted involving 518 patients with NVAF who underwent transesophageal echocardiography (TEE). Patients were categorized into a thrombus group (n = 96) and a non-thrombus group (n = 422). Clinical data were collected to calculate PERFAMLI and CHA₂DS₂-VASc scores. Receiver operating characteristic (ROC) curve analysis was performed to compare the discriminatory ability of both scoring systems. The area under the ROC curve (AUC) for the PERFAMLI score was 0.892 (95% CI: 0.852–0.931), significantly higher than that of the CHA₂DS₂-VASc score, which was 0.658 (95% CI: 0.595–0.722, p < 0.01). At an optimal cutoff of 4 points, the PERFAMLI score demonstrated a sensitivity of 87.50% and a specificity of 74.88%, yielding a Youden’s index of 0.62. In contrast, the CHA₂DS₂-VASc score showed a comparable sensitivity (86.46%) but substantially lower specificity (24.88%) at a cutoff of 2 points. Analysis of an expanded patient cohort (n = 1,015) showed consistent findings, with the AUC for PERFAMLI remaining stable at 0.881. In patients with CHA₂DS₂-VASc scores indicating low thromboembolic risk (< 2 points) but PERFAMLI scores suggesting a higher likelihood of atrial thrombosis (≥ 4 points), the PERFAMLI scoring system may provide complementary information to support individualized clinical evaluation.