Abstract 718: Role of CHADS2 Score in Evaluating Thromboembolic Risk in Patients With Atrial Fibrillation Undergoing Transesophageal Echocardiography Prior to DC Cardioversion
Background: The CHADS2 score has been used to evaluate the risk of left atrial appendage (LAA) thrombus in patients with atrial fibrillation (AF) prior to pulmonary vein isolation (PVI). However, little is known about the role of CHADS2 scoring for assessing the risk of thrombus in AF patients prior to DC cardioversion (DCC).
Objective: To determine the application of CHADS2 scores in stratifying AF patients undergoing screening transesophageal echocardiography (TEE) prior to DCC.
Methods: A total of 279 (66±13 yrs, 68% male) patients with AF on therapeutic anti-coagulation undergoing TEE to assess the presence of thrombus prior to DCC were identified in 2007 from Cleveland Clinic databases. A CHADS2 score (congestive heart failure, hypertension, age > 75, diabetes and stroke) was calculated for each patient. TEE studies were reviewed for spontaneous echo contrast (SEC), “sludge” and thrombus.
Results: The mean CHADS2 score was 1.78±1.2 with a score of 0, 1, 2, 3, 4 – 6 present in 16%, 29%, 29%, 18% and 7% of patients, respectively. On TEE, SEC was seen in 45% and sludge/thrombus in 8.6% of patients. The prevalence of LAA thrombus/sludge increased with ascending CHADS2 score [Scores 0 (0%), 1 (6.2%), 2 (11%), 3 (13 %), and 4 – 6 (13%)]. No patient with a CHADS2 score of 0 had LAA thrombus, however 36% had SEC.
Conclusions: In patients with AF undergoing DCC, the presence of sludge/thrombus by TEE increased as CHADS2 score increased, although SEC was seen across all scores. CHADS2 scoring may not be an effective risk stratification system in patients with AF undergoing TEE prior to DCC. In the future, new methods combining clinical and TEE findings may be needed in order to risk stratify these patients.