Abstract 14429: Identification of Thrombus in Left Atrial Appendage By 320-Row ADCT Confirms the Optimal Strategy of CHA2DS2-VASc Score for Initiating Anticoagulation Treatment in Patients With Atrial Fibrillation
Background: Atrial fibrillation (Af) is an important risk factor of stroke and left atrial appendage (LAA) is a major site of thrombus formation. CHADS2 and CHA2DS2-VASc scoring is a standard protocol for the determination of anticoagulation therapy in Af.
Aim: We attempted to investigate whether identifying thrombus in LAA by 320-row area-detector contrast-enhanced computed tomography (ADCT) is superior beyond CHADS2/ CHA2DS2-VASc score for the start of anticoagulation therapy in Af patients, as well as to confirm the much better strategy of CHA2DS2-VASc score than CHADS2 for initiating anticoagulation treatment in Af.
Methods: We performed 320-row ADCT in consecutive 99 patients with Af (age 72.3±8.4 years, male 79.8%, CHADS2 score 2.0±1.2, CHA2DS2-VASc score 3.0±1.3) for the detection of LAA thrombus. LAA thrombus was determined by early and delayed phases of 320-row ADCT and the relation of the presence or absence of LAA thrombus to CHADS2 and CHA2DS2-VASc score was investigated. Additionaly, both transesophageal echocardiography (TEE) and 320-row ADCT were performed in 34 Af patients, indicating the sensivity of 0.86 and the specificity of 0.90 by identification of LAA thrombus by 320-row ADCT.
Results: Surprisingly, 320-row ADCT detected LAA thrombus in 49 out of 99 patients with 2.1±1.2 and 3.2±1.2 of CHADS2 and CHA2DS2-VASc score, whereas those without thrombus were 1.9±1.2 and 2.9±1.4. Both values were not significantly different between thrombus and no thrombus groups. TEE and 320-row ADCT study showed a significant reduction in the emptying and filling velocity of LAA positive group compared to the thrombus negative group, respectively (p<0.01 and p<0.05). Interestingly, LAA thrombus was detected in 15 patients of CHADS2 score with 0 and 1 in all 49 patients with thrombus (30.6%). On the contrary, we found only 2 thrombus patients with 0 and 1 of CHA2DS2-VASc score, which was 4.1% in thrombus positive group (p<0.01).
Conclusions: We show that 320-row ADCT is a non-invasive diagnostic method to identify LAA thrombus and that CHA2DS2-VASc score appears to be optimal strategy for initiating anticoagulation therapy in Af.
- © 2013 by American Heart Association, Inc.