Predicting a decrease in left atrial appendage flow velocity using left atrial diameter and CHA2DS2-VASc score in patients with non-valvular atrial fibrillation

Q: What are the key findings of this study?

Left atrial diameter independently predicted decreased left atrial appendage flow velocity (OR 1.098, P<0.001), and combining it with CHA2DS2-VASc yielded an AUC of 0.733 in NVAF patients.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Non-valvular atrial fibrillation (NVAF) (n=716). Intervention: Left atrial diameter (LAD) combined with CHA2DS2-VASc score vs. Preserved left atrial appendage flow velocity (LAAFV ≥ 0.4 m/s). Primary outcome: Decrease in left atrial appendage flow velocity (LAAFV < 0.4 m/s) (OR 1.098, 95% CI 1.049-1.149, p=<0.001).

Q: What does this research mean for the field?

Left atrial diameter independently predicts decreased left atrial appendage flow velocity, and combining it with the CHA2DS2-VASc score improves predictive performance for decreased flow velocity in patients with non-valvular atrial fibrillation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate whether combining left atrial diameter with the CHA2DS2-VASc score provides an accurate, non-invasive method to predict decreased left atrial appendage flow velocity in patients with non-valvular atrial fibrillation.

Guangyu Wang; Guangyu Li; Feng Hu; Minhua Zang; Jun Pu

doi:10.1186/s12872-022-03033-6

April 3, 2023BMC Cardiovascular DisordersOpen Access

Predicting a decrease in left atrial appendage flow velocity using left atrial diameter and CHA2DS2-VASc score in patients with non-valvular atrial fibrillation

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Key result

Larger left atrial diameter linked to ~10% higher odds of sluggish LAA flow in NVAF.

OR 1.098
95% CI 1.049-1.149
P<0.001
n=716

Why the study?

Left atrial appendage flow velocity (LAAFV) is a classic but invasive predictor of thromboembolic events in AF, motivating evaluation of easily available, non-invasive left atrial diameter combined with CHA2DS2-VASc score for predicting decreased LAAFV in non-valvular AF.

Does combining left atrial diameter (LAD) with the CHA2DS2-VASc score improve the prediction of decreased left atrial appendage flow velocity (<0.4 m/s) in patients with non-valvular atrial fibrillation?

Key Points

To evaluate whether combining left atrial diameter with the CHA2DS2-VASc score provides an accurate, non-invasive method to predict decreased left atrial appendage flow velocity in patients with non-valvular atrial fibrillation.
Analyzed 716 consecutive patients with non-valvular atrial fibrillation who underwent transesophageal echocardiography.
Divided patients into a decreased flow velocity group (< 0.4 m/s, n = 354) and a preserved flow velocity group (≥ 0.4 m/s, n = 362).
Identified independent predictors using multivariate linear and logistic regression, and evaluated diagnostic accuracy using receiver operating characteristic curve analysis.
Independent risk factors for decreased flow velocity on multivariate logistic regression included left atrial diameter (OR 1.098, 95% CI 1.049–1.149, P < 0.001), brain natriuretic peptide concentration (OR 1.003, 95% CI 1.001–1.005, P = 0.003), persistent atrial fibrillation (OR 0.159, 95% CI 0.102–0.247, P < 0.001), and age (OR 1.044, 95% CI 1.013–1.075, P = 0.005).
Left atrial diameter and CHA2DS2-VASc scores were significantly higher in the decreased group than in the preserved group (46.3 ± 4.9 mm vs. 41.1 ± 5.3 mm, and median 4 vs. 2, respectively; both P < 0.001).
The combined score of left atrial diameter and CHA2DS2-VASc achieved an area under the curve of 0.733 (95% CI 0.697–0.770, P < 0.001) with a cutoff value of 4 points (sensitivity: 70%, specificity: 69%).

Study Design

Type

Cross-Sectional (n=716)

Multicenter

No

Structured PICO

Does combining left atrial diameter (LAD) with the CHA2DS2-VASc score improve the prediction of decreased left atrial appendage flow velocity (<0.4 m/s) in patients with non-valvular atrial fibrillation?

P

Population

716 consecutive adults with non-valvular atrial fibrillation undergoing transthoracic and transesophageal echocardiography at a single center in China between January 2019 and October 2021.

E

Exposure

Left atrial diameter (LAD) measured by 2D transthoracic echocardiography combined with CHA2DS2-VASc score (novel combined score with optimal cutoff of 4.0 points, adding 1 point when LAD > 42.5 mm)

C

Comparator

CHA2DS2-VASc score alone (cutoff 2.5 points) and LAD alone (cutoff 42.5 mm); patients stratified into decreased LAAFV (<0.4 m/s) vs preserved LAAFV (≥0.4 m/s) groups

O

Outcome

Decrease in left atrial appendage flow velocity (LAAFV < 0.4 m/s) measured by pulsed Doppler transesophageal echocardiography at 1 cm from the LAA orifice averaged over 5 cardiac cyclessurrogate

Main Result

Odds Ratio: 1.098 (95% CI 1.049–1.149)

p-value: p=<0.001

Combining non-invasive transthoracic left atrial diameter with the clinical CHA2DS2-VASc score improves specificity and overall discrimination compared to CHA2DS2-VASc alone for identifying NVAF patients with reduced left atrial appendage flow velocity.

Limitations

Single-center retrospective study
Lack of information in medical records on whether patients were in AF rhythm during TEE
No uniform criteria or standardized measurement method for decrease in LAAFV across studies
Selection bias as patients were prepared for catheter ablation or LAA occlusion
Used easily-obtained LAD rather than the more accurate LA volume index
Single-center retrospective study design
Missing data on whether patients were in AF rhythm during TEE
Lack of uniform criteria for defining decreased LAAFV in AF patients
Patients were prepared for catheter ablation or LAA occlusion, limiting generalizability to all NVAF patients
Left atrial volume index was not routinely measured, so LAD was used instead

Implication

Adding LAD to CHA2DS2-VASc modestly improves discrimination for low LAA flow velocity; hypothesis-generating for stroke risk stratification in NVAF.

Abstract

Background Left atrial (LA) appendage flow velocity (LAAFV) is a classic but invasive predictor of thromboembolic events in patients with atrial fibrillation (AF). We aimed to explore the usefulness of LA diameter (LAD) combined with CHA 2 DS 2 -VASc score, which is easily available and non-invasive, as a novel score for predicting a decrease in LAAFV in non-valvular AF (NVAF). Methods In total, 716 consecutive NVAF patients who underwent transesophageal echocardiography were divided into the decreased LAAFV (< 0.4 m/s) and preserved LAAFV (≥ 0.4 m/s) groups. Results The decreased LAAFV group had a larger LAD and a higher CHA 2 DS 2 -VASc score than the preserved LAAFV group ( P < 0.001). Multivariate linear regression indicated that brain natriuretic peptide (BNP) concentration, persistent AF, LAD, and CHA 2 DS 2 -VASc score were remained inversely associated with LAAFV. Moreover, multivariate logistic regression revealed that BNP concentration (odds ratio [OR] 1.003, 95% confidence interval [CI] 1.001–1.005, P = 0.003), persistent AF (OR 0.159, 95% CI 0.102–0.247, P < 0.001), and LAD (OR 1.098, 95% CI 1.049–1.149, P < 0.001) were independent factors for a decrease in LAAFV. A novel score, LAD combined with CHA 2 DS 2 -VASc score, was more accurate for predicting a decrease in LAAFV among NVAF patients (area under the curve was 0.733). Conclusion Enlarged LAD was independent risk factor for a decrease in LAAFV among NVAF patients. LAD combined with CHA 2 DS 2 -VASc score enhanced the predictive ability for a decrease in LAAFV among NVAF patients.

Discussion

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Cite This Study

Wang et al. (2023) conducted a cross-sectional in Non-valvular atrial fibrillation (NVAF) (n=716). Left atrial diameter (LAD) combined with CHA2DS2-VASc score vs. Preserved left atrial appendage flow velocity (LAAFV ≥ 0.4 m/s) was evaluated on Decrease in left atrial appendage flow velocity (LAAFV < 0.4 m/s) (OR 1.098, 95% CI 1.049-1.149, p=<0.001). Left atrial diameter independently predicted decreased left atrial appendage flow velocity (OR 1.098, P<0.001), and combining it with CHA2DS2-VASc yielded an AUC of 0.733 in NVAF patients.

synapsesocial.com/papers/6addf7d0271a360218af9561 https://doi.org/10.1186/s12872-022-03033-6

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Predicting a decrease in left atrial appendage flow velocity using left atrial diameter and CHA2DS2-VASc score in patients with non-valvular atrial fibrillation

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Predicting a decrease in left atrial appendage flow velocity using left atrial diameter and CHA2DS2-VASc score in patients with non-valvular atrial fibrillation

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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