Abstract 18037: Left Atrial Appendage Emptying Flow Velocity Significantly Correlates with CHA₂DS₂-VASc Score, Not with CHADS₂

Abstract

Background: Left atrial appendage (LAA) flow velocity by transesophageal echocardiography (TEE) associates with thromboembolic events. CHA₂DS₂-VASc score also predicts future thromboembolism, which is superior to CHADS₂ score. However, the relation between LAA flow and CHA₂DS₂-VASc score is unknown. We examined the relationship between LAA flow and CHADS_2/CHA₂DS₂-VASc score.

Methods: We studied 155 consecutive patients (age: 65±13, 111 males) who underwent TEE for evaluation of LAA thrombus from 2008 to 2011. Patients with dialysis or more than mild valvular heart disease were excluded. Both CHADS₂ and CHA₂DS₂-VASc score were compared with LAA emptying flow velocity and BNP.

Results: The patients cardiac rhythm at TEE were 83 sinus rhythm(54%), 67 atrial arrhythmia 67 (43%), 5 pacemaker rhythm (3%). There were 59 patients with heart failure, 81 hypertension, 27 diabetes mellitus and 53 vascular diseases. Their CHADS₂ and CHA₂DS₂-VASc were 2.0±1.2 and 3.3±1.9, respectively. Estimated glomerular filtration rate (77.1±28.7 ml/min) was significantly associated with both score (p=0.005 vs CHADS₂, p=0.0005 vs CHA₂DS₂-VASc). However, LAA flow (45±26 cm/s) and BNP (239±324 pg/ml) significantly correlated with CHA₂DS₂-VASc (vs LAA flow, p=0.0035; vs LogBNP p=0.030), but not with CHADS₂ (p=0.059; p=0.160). In multivariate analysis with the factors in CHA₂DS₂-VASc, advanced age (p=0.002) and heart failure (p=0.025) were independently associated with LAA flow. The comparison of age groups used in CHA₂DS₂-VASc score showed there was significant difference of LAA emptying flow between younger group (<65 yrs, score = 0) and middle group (score =1, 65-74yrs; p=0.001). However there was no significant difference in LAA emptying flow between the middle group and older group (>75yrs, score=2; p=0.578).

Conclusion: CHA₂DS₂VASc score significantly correlated with LAA flow and BNP but CHADS₂ did not. Age and heart failure were independent predictors for LAA flow.