Key result
Adding impaired LA function to CHADS2 improves prediction of dense SEC or thrombus.
Why the study?
Does combining left atrial functional parameters with CHADS2 and CHA2DS2-VASc scores improve the prediction of left atrial thrombus or dense spontaneous echo contrast in patients with non-valvular atrial fibrillation?
Observational (n=526)
No
Does combining left atrial functional parameters with CHADS2 and CHA2DS2-VASc scores improve the prediction of left atrial thrombus or dense spontaneous echo contrast in patients with non-valvular atrial fibrillation?
Effect estimate: c-statistic 0.78 (95% CI 0.74-0.81)
Absolute Event Rate: 0.78% vs 0.65%
p-value: p=<0.001
Adding left atrial functional parameters (LA emptying fraction < 30%) to CHADS2 or CHA2DS2-VASc scores significantly improves the detection of LA thrombus or dense spontaneous echo contrast in patients with non-valvular AF.
May refine thrombus risk stratification in non-valvular AF; hypothesis-generating and requires prospective validation before practice change.
The discriminative ability of the widely used CHADS2 and CHA2DS2-VASc scores for risk stratification of thromboembolism in atrial fibrillation (AF) is known as modest. Some echocardiographic parameters are known risk factors for thromboembolism. This study aimed to evaluate whether combining echocardiographic parameters with CHADS2 and CHA2DS2-VASc scores can improve the predictive power for embolic risk in AF.A total of 526 (F/M = 83/433, mean age = 57.6 ± 10.7 years) patients with non-valvular AF were enrolled. The predictability for left atrial (LA) thrombus or dense spontaneous echo contrast (SEC) using clinical scores or echocardiographic parameters or combining clinical scores and echocardiographic parameters was calculated and compared.Dense SEC or thrombus was present in 51 patients. The predicting powers of the CHADS2 and CHADS2-VASc scores for the presence of dense SEC or thrombus were modest (c-statistics 0.65 and 0.68, respectively, 95% confidence interval [CI] 0.61-0.69 and 0.64-0.74, respectively, both P < 0.001). Impaired LA function was the most descriptive predictor for the presence of thrombus or dense SEC among echocardiographic parameters. Combining impaired LA function (LA emptying fraction < 30%) with the CHADS2 and CHA2DS2-VASc scores showed the improvement of predictive power in detecting dense SEC or thrombus (c-statistics 0.78 and 95% CI 0.74-0.81 and c-statistics 0.77 and 95% CI 0.73-0.81, respectively, both P < 0.001).Adding LA functional markers to the CHADS2 or CHA2DS2-VASc score improved the predictive value of the presence of thrombus or dense SEC. In clinical situations, anticoagulation should be considered to prevent embolism in patients with low-risk scores when they have LA dysfunction.
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Kim et al. (2015) conducted an observational in Non-valvular atrial fibrillation (n=526). Impaired left atrial function (LA emptying fraction < 30%) combined with CHADS2 score vs. CHADS2 score alone was evaluated on Predictive power (c-statistic) for the presence of dense spontaneous echo contrast (SEC) or thrombus (c-statistic 0.78, 95% CI 0.74-0.81, p=<0.001). Adding impaired left atrial function to the CHADS2 score significantly improved the predictive power for detecting dense spontaneous echo contrast or thrombus (c-statistic 0.78 vs 0.65, P<0.001).
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