Key result
Higher CHA2DS2-VASc score is linked to worse left atrial strain in sinus rhythm, mediated by LVDD.
Why the study?
Individual components of the CHA2DS2-VASc score may affect left atrial function, but whether left atrial function assessed by speckle-tracking echocardiography differs in sinus rhythm patients according to score was unknown.
Cross-Sectional (n=150)
Increased CHA2DS2-VASc scores in patients with sinus rhythm correlate with reduced left atrial reservoir and conduit strain, indicating early left atrial pathology that is largely mediated by left ventricular diastolic dysfunction.
Answers are grounded in this paper and cite their sources.
Should not yet change risk stratification in sinus rhythm; leaves open whether LA strain adds independent prognostic value.
Background The CHA 2 DS 2 -VASc score is an established tool for thromboembolic risk assessment in atrial fibrillation. Individual components of the score may affect left atrial (LA) function. Speckle-tracking echocardiography (STE) enables detection of early, subtle changes in the LA. This study aimed to test whether LA function, as assessed by STE, differs among patients with sinus rhythm according to their CHA 2 DS 2 -VASc score. Methods This study included 150 patients with sinus rhythm. They were grouped by CHA 2 DS 2 -VASc score: low (1 for women, 0 for men), moderate (2 for women, 1 for men), and high (≥ 3 for women, ≥ 2 for men), with 50 patients per group. All participants gave written consent, provided medical histories, underwent a 12-lead electrocardiogram, and received standard echocardiography and STE. Results The high-risk group had significantly lower LA reservoir strain (LASr) and LA conduit strain (LAScd) compared to the moderate- and low-risk groups (high vs. moderate vs. low: LASr, 33.2 ± 7.1 vs. 36.9 ± 6.1 vs. 40.6 ± 5.6; LAScd, 20.3 ± 5.7 vs. 23.5 ± 4.8 vs. 26.9 ± 3.9), with all P-values of < 0.01. Moderate-risk patients also showed lower strain values than low-risk patients. In contrast, LA maximal volume index did not differ among the groups ( P = 0.536). Mediation analysis showed that the association between the score and LAScd was statistically mediated by left ventricular (LV) diastolic dysfunction (89.7%) with no significant direct association ( P = 0.342). For LASr, 62.4% of the association was statistically mediated by LV diastolic dysfunction, with a residual direct statistical association remaining (β = –0.139, P = 0.008). Conclusions Increased CHA 2 DS 2 -VASc scores correlated with reduced LASr and LAScd. The association with LAScd was mainly mediated by LV diastolic dysfunction. A direct statistical association of the score was noted with LASr, indicating possible early LA pathology. Further research should assess the clinical relevance of these echocardiographic findings for risk stratification in patients with high CHA 2 DS 2 -VASc score.
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Mahmoud et al. (2026) conducted a cross-sectional in Sinus rhythm (n=150). High CHA2DS2-VASc score vs. Low CHA2DS2-VASc score was evaluated on Left atrial reservoir strain (LASr) (p=<0.01). Higher CHA2DS2-VASc scores in patients with sinus rhythm were significantly associated with reduced left atrial reservoir and conduit strain, largely mediated by left ventricular diastolic dysfunction.
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