Abstract 16826: Left Atrial Functional Parameters Measured By Echocardiography Added To The CHADS2 Or The CHA2DS2-vasc Score Improves Predicting Power For Thromboembolic Risk In Atrial Fibrillation

Abstract

Background: CHADS2 and CHA2DS2-VASc score are used for evaluation of embolic risk in atrial fibrillation(AF) patients. The left atrial(LA) function is an important risk factor for embolism in AF. The aim of this study was to evaluate 1. the predictive power of CHADS2 and CHA2DS2-VASc score for presence of SEC, 2. the predictive power of CHADS2 and CHA2DS2-VASc scores combining LA functional parameters measured by trans-thoracic echocardiography(TTE) for embolic risk in AF.

Methods: 455(F/M=73/382 mean age=57±10.4) patients with non-valvular AF who had taken TTE and trans-esophageal echocardiography were enrolled. CHADS2 and CHA2DS2-VASc scores were calculated. LA volume, LA emptying fraction(EF), LAA emptying velocity, LAA EF and the presence of SEC and thrombus were evaluated.

Results: SEC was present in 149 patients and LA thrombus in 4 patients. The predictability for the presence of SEC and thrombus was slightly superior using CHA2DS2-VASc score than CHADS2 score. (AUC;0.640 , P<0.001 and AUC;0.621, P<0.001, respectively). When TTE parameters such as increased LAVI(>40ml/m2) or impaired LAEF(≤35%) combined to clinical scores, the predictive power for detecting SEC and thrombus was improved (Table 1). Further, the presence LA dysfunction and increased LA volume increased the relative risk of SEC and thrombus by TEE with odd ratio in clinically low risk patients (0 and 1 CHADS2 and CHA2DS-VAS score)(Table 2)

Conclusion: LA function markers measured by TTE added to the CHADS2 or the CHA2DS2-VASc scores may improve the predictive value of presence of SEC and thrombus. Because the presence of LA dysfunction and increased LA volume was associated with the embolic risk, anticoagulation should be considered in clinically low risk group of patients.