Abstract 12558: Cha2ds2-vasc Score as a Predictor of a Left Atrial Thrombus in Patients With Nonvalvular Atrial Fibrillation
Background: The risk of chronic thromboembolism in patients with atrial fibrillation (AF) can be evaluated using the CHA2DS2-VASc score, which is based on clinical parameters. We examined whether this score predicts left atrial (LA) thrombus detected on precardioversion transesophageal echocardiography (TEE).
Methods: We reviewed medical records of the patients who have undergone TEE to assess the presence of LA thrombus prior to DC cardioversion for AF. CHA2DS2-VASc score (congestive heart failure, hypertension, age, diabetes, stroke, female gender, vascular disease) was calculated for each patient. Clinical TEE reports were reviewed for the presence of LA thrombus. Patients with valve prosthesis or rheumatic mitral valve disease were excluded from the study.
Results: A total of 309 (70,1 ± 9,8 yrs, 49% male) patients were identified. LA thrombus was detected in 32 of 309 (10.3%) patients. There were 50 patients with low CHA2DS2-VASc score (0-1), 230 patients with intermediate score (2-4), and 29 patients with high (5-9) score. The incidence of LA thrombus in low, intermediate and high CHA2DS2-VASc score groups was 0%, 4.8%, 72.4%, respectively. LA thrombus risk increased with CHA2DS2-VASc score. Patients in the high CHA2DS2-VASc score group had 64 times higher risk (%95 CI= 21-204) for the presence of LA thrombus.
Conclusion: High CHA2DS2-VASc score is strongly associated with the presence of LA thrombus in patients with AF. We think that effective anticoagulant therapy should be questioned in patients who will undergo TEE to assess the presence of LA thrombus prior to DC cardioversion for AF, if CHA2DS2-VASc score is ≥ 5. If the patient is not taking effective anticoagulant therapy, TEE may be postponed after 4 weeks of effective anticoagulant therapy.
- © 2012 by American Heart Association, Inc.