Key result
High CHIRP3-M-1 score linked to ~158% greater odds of reduced LAAev versus intermediate scores.
Why the study?
LAAev measured on TEE is a marker of thromboembolic risk in AF, motivating an evaluation of predictors of reduced LAAev to identify individuals at increased cardioembolic stroke risk.
Does the CHIRP3(M-1) score predict reduced left atrial appendage emptying velocity in patients undergoing transesophageal echocardiogram?
Observational (n=995)
No
Does the CHIRP3(M-1) score predict reduced left atrial appendage emptying velocity in patients undergoing transesophageal echocardiogram?
Effect estimate: OR 2.58 (95% CI 1.45-4.61)
p-value: p=0.001
The novel CHIRP3(M-1) score using clinical and echocardiographic variables can predict reduced left atrial appendage emptying velocity, a marker of cardioembolic stroke risk.
CHIRP3(M-1) may refine pre-TEE stroke risk assessment; hypothesis-generating and requires prospective validation before clinical use.
BACKGROUND: Atrial fibrillation (AF) leads to impaired left atrial appendage contractility, increasing the risk of thromboembolic stroke. The left atrial appendage emptying velocity (LAAev) measured on transesophageal echocardiogram (TEE) is a marker of increased thromboembolic risk. OBJECTIVES: The purpose of this study was to evaluate predictors of reduced LAAev for identifying individuals at increased risk for cardioembolic stroke. METHODS: This was a single-center retrospective review of TEEs and clinical charts. Predictors of LAAev <30 cm/s were identified using logistic regression. A risk prediction model was created using stepwise selection in a derivation set (n = 695) and separately tested in a validated set (n = 300). RESULTS: (1), current Rhythm AF (1), Paroxysmal AF (2), Persistent AF (3), longstanding Persistent/permanent AF (4), and greater than moderate Mitral regurgitation (-1). In the validation set, as compared to intermediate scores (3-4), those with low scores (≤2) and high scores (≥5) had odds ratios for LAAev <30 cm/s of 0.41 (0.21, 0.78, P = .007) and 2.58 (95% confidence interval 1.45-4.61, P = .001), respectively. CONCLUSION: We developed and validated a novel risk stratification system to predict reduced LAAev using clinical and echocardiographic variables. This may help refine the stratification of cardioembolic stroke risk.
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Tabak et al. (2024) conducted an observational in Atrial fibrillation (n=995). CHIRP3(M-1) score vs. Intermediate scores (3-4) was evaluated on Left atrial appendage emptying velocity (LAAev) <30 cm/s (OR 2.58, 95% CI 1.45-4.61, p=0.001). A high CHIRP3(M-1) score (≥5) predicted reduced left atrial appendage emptying velocity (<30 cm/s) compared to intermediate scores (OR 2.58; 95% CI 1.45-4.61; P=0.001).
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