Abstract 18286: Left Atrial Spontaneous Echocardiographic Contrast is a Predictor of Cardiovascular Events (Death, Stroke, Heart Failure) Beyond the CHA2DS2VASc Score at Long-term Follow-up in a Single-Center Cohort of Patients with Non Valvular Atrial Fibrillation
Background: The CHA2DS2VASc score has been proposed as an additional tool in thromboembolic (TE) risk stratification, beyond the CHADS2 score, in patients with non-valvular atrial fibrillation (NVAF). The role of additional TE risk markers, i.e. derived from echocardiography, has not been yet fully evaluated. We aimed to evaluate in a multivariate model the role of clinical versus TEE parameters in predicting cardiovascular (CV) events at long-term follow-up.
Methods: In 763 consecutive patients hospitalized for NVAF, TEE was systematically performed within 24h after admission. All patients were followed-up (mean 5.8 ± 4.1 years) and cardiovascular (CV) events (stroke, death, or heart failure) defining a composite endpoint were recorded.
Results: Two hundred and five patients (26.9%) had a CHADS2=0, 228 (29.9%) a CHADS2=1, and 330 (43.3%) a CHADS2≥2. The corresponding figures for the CHA2DS2VASc score were 92 (12.1%), 115 (15.1) and 556 (72.9%), respectively. Left atrial spontaneous contrast (LASEC) was present in 358 (46.9%), described as mild in 212 (27.8%), moderate in 111 (14.6%) and severe in 35 (4.6%). LA thrombus was found in 17 patients (2.2%) and protruding aortic atheroma ≥4 mm in 116 (15.2%). Six hundred thirty three patients (83%) were prescribed warfarin and 158 (27%) aspirin at discharge. At follow-up, death occurred in 253 patients (33.2%), stroke in 29 (3.8%) and heart failure in 100 (13.1%). The Kaplan-Meier curves showed that a CHA2DS2VASc score >3 was associated with a higher risk of CV events. In the multivariate analysis, non paroxysmal AF (HR 1.54, 95%CI 1.17-2.01), CHA2DS2VASc score (HR 1.47, 95%CI 1.38-1.57) and LASEC (presence/absence, HR 1.42 95%CI 1.11-1.82) were predictors of CV events. Warfarin treatment at discharge was protective (HR 0.65, 95%CI 0.48-0.87).
Conclusions: TEE-detected LA spontaneous echocardiographic contrast in NVAF patients is associated with a higher risk of CV events, beyond the CHA2DS2VASc score and the type of AF.
- © 2012 by American Heart Association, Inc.