Abstract 719: CHADS2 Score is Predictive of Left Atrial Thrombus on Precardioversion Transesophageal Echocardiography in Atrial Fibrillation
Background: It is unknown if CHADS2 score, a marker of chronic thromboembolic risk in atrial fibrillation (AF), predicts left atrial (LA) thrombus on precardioversion transesophageal echocardiography (PCTEE).
Methods: We retrospectively studied patients undergoing PCTEE for nonvalvular AF at a tertiary hospital. Clinical TEE reports were reviewed for the presence of LA thrombus. Using medical records and an ICD-9 coding database, CHADS2 score was derived by assigning 1 point for congestive heart failure (CHF), hypertension, age ≥ 75, and diabetes and 2 points for stroke or transient ischemic attack. The association between CHADS2 and thrombus was evaluated with Mantel-Haenszel Chi-Square. The relation between the singular components of CHADS2 and thrombus were analyzed using Pearson’s Chi-Square.
Results: In 643 consecutive patients undergoing PCTEE for AF, LA thrombus was identified in 46 (7.2 %). A strong association was present between the CHADS2 score and LA thrombus (p = 0.0003, Figure⇓). No thrombi were identified in patients with CHADS2 = 0 (RR = 0.91, 90 % CI 0.89 – 0.93, p = 0.0003). A CHADS2 score ≥ 1 was associated with a 9% increased risk of thrombus (RR 1.09, 90 % CI 1.07–1.12, p = 0.0003). Among the 13 (7.7 %) patients with thrombus in the CHADS2 = 1 group, all had CHF. Of the singular components of CHADS2, CHF was the only factor independently associated with thrombus (p < 0.0001), whereas no association was present for hypertension (p = 0.43), age (p = 0.42), diabetes (0.18), or stroke (0.13).
Conclusion: In AF, CHADS2 is strongly associated with LA thrombus on PCTEE. Our findings support using PCTEE if the CHADS2 score is ≥ 1 and suggest PCTEE may be unnecessary if the CHADS2 score = 0.