Abstract 17079: CHA2DS2-vasc Score is More Sensitive in Predicting Thromboembolic Risk Than CHADS2 Score in Atrial Fibrillation

Abstract

Background: CHADS2 score has been revised as CHA2DS2-VASc score for better thromboembolic risk stratification in patients with atrial fibrillation(AF). Impaired left atrial(LA) and left atrial appendage(LAA) function has been considered to be important determinant of thrombus formation in AF. The aim of this study was to evaluate the relation between 2 clinical risk scores and known echocardiographic(ECHO) risk factors of embolism in AF patients.

Methods: 455(F/M=73/382 mean age=57±10.4) patients with non-valvular AF who had trans-thoracic echocardiography (TTE) and trans-esophageal echocardiography were enrolled. CHADS2 and CHA2DS2-VASc scores were calculated and correlated to echocardiographic findings. LA volume, LA emptying fraction (EF), LAA emptying velocity, LAA EF, the presence of dense SEC, the presence of thrombus and the presence of left ventricular hypertrophy (LVH)(defined as >115g/m2 in men, >95 g/m2 in women) were evaluated.

Results:Increased LAV(LAVI≥40ml/m2) was founded in 165 patients, impaired LAEF(≤35%) in 253 patients, decreased LAA emptying velocity(≤20cm/s) in 75 patients, decreased LAA EF(≤30%) in 191 patients, SEC in 149 patients and LA thrombus in 4 patients. The patients of CHADS2 and CHA2DS2-VASc with ≥2 score was 82 and 173 respectively. In univariate analysis, both clinical score with ≥ 2 were related with the ECHO risk factors of thromboembolism. But in multivariate analysis, low LAA EF and the presence of LVH was independently related with ≥ 2 CHADS2-vasc score only. Impaired LAEF was related with both clinically higher score grades.(Table 1)

Conclusion: ECHO marker of LA dysfunction was closely related clinically higher CHADS2 and CHA2DS2-VASc scores. Especially LAA dysfunction and LVH were independently related with ≥ 2 CHA2DS2-vasc, but not with ≥ 2 CHADS2 score. CHA2DS2-vasc score appears to be more sensitive than CHADS2 score in detecting high risk AF patients for thrombus formation..