Analysis of risk factors for thrombosis of the left atrium/left atrial appendage in patients with non-valvular atrial fibrillation.

Abstract

Left atrial appendage (LAA) morphology is a powerful predictor of thrombogenesis of the left atrium (LA) in patients with non-valvular atrial fibrillation (NVAF). However, it remains unknown whether LAA morphology is useful for stroke risk stratification in patients with NVAF. A total of 555 atrial fibrillation patients were divided into thrombus and non-thrombus groups according to transoesophageal echocardiography. We analysed the correlation between LAA morphology and the CHADS2 score. We determined the L2CHADS2 score and compared the ability to predict LA/LAA thrombosis of the CHADS2, L2CHADS2 and CHA2DS2-VASc scores from the area under the curve (AUC). The odds ratio of non-chicken wing LAA morphology was 11.48. Non-chicken wing LAA morphology was significantly correlated with LA/LAA thrombosis. We incorporated LAA morphology into the CHADS2 score and named it the L2CHADS2 score. The AUC of the L2CHADS2 score (0.767) in predicting LA/LAA thrombosis was significantly higher than that of the CHADS2 (0.558) or CHA2DS2-VASc scores (0.557). The positive and negative predictive values of the L2CHADS2 score (13.1 and 98.7%) were higher than those of the CHADS2 (8.7 and 94.2%) and CHA2DS2-VASc scores (6.9 and 6.9%). Non-chicken wing LAA morphology was a powerful predictor of LA/LAA thrombosis in NVAF patients. The AUC, sensitivity and specificity of the L2 CHADS2 score were higher than those of the CHADS2 and CHA2 DS2 -VASc scores.