Abstract
Aim: A high CHADS2- as well as CHA2DS2-Vasc-Score on the one hand, and left atrial emptying velocity < 20 cm/s (LAAEV) on the other hand have been separately proposed for risk assessment in patients (pts) with atrial fibrillation (AF). The aim of this study was the analysis of the relation between the CHADS2- and CHA2DS2-Vasc-Score as well as the left atrial emptying velocity (LAAEV), the severity of blood stasis (spontaneous echo contrast, SEC), and presence of LAA thrombi as assessed by transesophageal echocardiography (TOE) in pts with persistent AF. Methods: The clinical risk of thromboembolism was assessed with the CHADS2 and CHA2DS2-Vasc-Score in 150 patients (pts) with persistent AF, who had been headed for TOE-guided electrical cardioversion. LAAEV (averaged over 10 beats), SEC, and LAA thrombi were determined by TOE. Results: The 150 pts (age 69±13 years) had a mean LAAEV of 34±19 cm/s, 61 pts had no SEC (41%; SEC I: 37 pts; SEC II: 23 pts; SEC III 22 pts), and 29 LAA-thrombi were detected by TOE (LAAEV 50 cm/s: 25 pts, all without LAA-thrombi). The mean CHADS2-Score was 1.9±1.2 (CHADS2 ≥2: 63 %) and the CHA2DS2-Vasc-Score was 3.2±1.8 (CHADS2-Vasc ≥2: 39/46, 89%). There was a moderate inverse correlation between LAAEV and SEC (r: -0.55, p<0.001), and a weak inverse correlation between LAAEV and the CHADS2- (r: -0.28) as well as CHA2DS2-Vasc-Score (r: -0.28). Moreover, Pts with a CHADS-Score ≥ 2 had a significant reduction of the LAAEV in comparison to pts with a CHADS-Score < 2 (29±16 cm/s vs. 41±20 cm/s; p < 0,001). Conclusion: This study demonstrated a significant reduction of the LAAEV in pts with a CHADS-Score ≥ 2, and a moderate inverse correlation between the CHADS2-Score and the LAAEV. Due to the fact that low LAAEV (< 20 cm/s) on the one hand, and high CHADS2- as well as CHA2DS2-Vasc-Score on the other hand are predictive for the thromboembolic risk in AF, it might be a promising approach to combine clinical and echocardiographic risk assessments for individual decision making regarding the optimal therapy and risk stratification.
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