Key result
Novel TEE-risk score outperforms modified CHADS2 score for predicting TEE-detected stroke risk with ~0.85 AUC.
Why the study?
Catheter ablation carries a risk of perioperative thromboembolism even in AF patients with low CHADS2 scores, prompting investigation into whether clinical variables can predict TEE-assessed stroke risk factors.
Does a novel clinical and imaging scoring system (TEE-risk score) improve prediction of transesophageal echocardiography-determined stroke risk compared to the modified CHADS2 score in Japanese atrial fibrillation patients with a CHADS2 score of 0 or 1?
Cross-Sectional (n=209)
No
Does a novel clinical and imaging scoring system (TEE-risk score) improve prediction of transesophageal echocardiography-determined stroke risk compared to the modified CHADS2 score in Japanese atrial fibrillation patients with a CHADS2 score of 0 or 1?
A novel TEE-risk score combining persistent AF, left atrial diameter >41 mm, BNP >47 pg/mL, and CT contrast medium defect accurately identifies echocardiographic stroke risk in AF patients with low CHADS2 scores (0-1) undergoing catheter ablation.
Answers are grounded in this paper and cite their sources.
May support refined risk stratification in low-CHADS2 AF; leaves open prospective outcome validation before clinical adoption.
Background Catheter ablation is an effective treatment for atrial fibrillation (AF), but it carries risk of perioperative thromboembolism even in cases with low CHADS2 scores. Here, we examined whether a combination of clinical variables can predict stroke risk factors that are assessed by transesophageal echocardiography (TEE). Methods The study population consisted of 209 consecutive AF patients with a CHADS2 score of 0 or 1 (58.7 ± 10.6 years old; persistent AF, 33.0%). All patients underwent TEE, and TEE‐determined stroke risk (TEE risk) was defined as cardiac thrombus/sludge, dense spontaneous echo contrast (SEC), and/or peak left atrial appendage (LAA) flow velocity <0.25 m/s. Results Transesophageal echocardiography risk was observed in 10.5% of the patients. In multivariate logistic analysis, persistent AF [odds ratio (OR): 11.5, CI: 3.14‐42.1, P = .0002], left atrial diameter (LAD) (OR: 1.10, CI: 1.01‐1.20, P = .0293), contrast medium defect (CMD) in the LAA detected by computed tomography (OR: 20.2, CI: 6.3‐65.0, P < .0001), and serum brain natriuretic peptide (BNP) level (OR: 1.00, CI: 1.00‐1.01, P = .0056) were independent predictors of TEE risk. A new scoring system comprising LAD > 41 mm (1 point), BNP > 47 pg/mL (1 point), CMD (2 points), and persistent AF (2 points) was constructed and defined as TEE‐risk score. The area under the curve (AUC) for prediction of TEE risk was 0.631 in modified CHADS2 score and it was 0.852 in TEE‐risk score. Conclusion Transesophageal echocardiography risk is predictable by TEE‐risk score, and its combination with CHADS2 score may improve the stroke risk stratification in AF patients with a low CHADS2 score.
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Nagahara et al. (2020) conducted a cross-sectional in Atrial fibrillation with low CHADS2 score (0 or 1) scheduled for catheter ablation (n=209). TEE-risk score (LAD > 41 mm, BNP > 47 pg/mL, CT contrast medium defect in LAA, persistent AF) vs. Modified CHADS2 score was evaluated on TEE-determined stroke risk (cardiac thrombus/sludge, dense spontaneous echo contrast, and/or peak LAA flow velocity <0.25 m/s) (AUC 0.852 vs 0.631, p=0.0025). The novel TEE-risk score predicted transesophageal echocardiography-determined stroke risk with higher accuracy than the modified CHADS2 score.
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