Association between Morphodynamic Variables by Transesophageal Echocardiography and CHA2DS2-Vasc Values

Renata Rejane Linhares,Andresa Paes Da Cruz,Carlos Eduardo Suaide Silva,Luciana Braz Peixoto,Rodrigo Bellio De Mattos Barretto,Luara Piovam Garcia,David Costa De Souza Le Bihan,Dalmo Antonio Ribeiro Moreira

doi:10.5935/2359-4802.20190017

Renata Rejane Linhares, Andresa Paes Da Cruz + Show 6 more

Open Access

https://doi.org/10.5935/2359-4802.20190017

Copy DOI

Abstract

Abstract Background: In atrial fibrillation (AF), the CHA2DS2-VASc score calculates the risk for stroke. Di Biase classified the left atrial appendage (LAA), using magnetic resonance imaging, into 4 morphological types and correlated it with cerebrovascular events. Transesophageal echocardiography (TEE) also evaluates LAA and is a more widespread technique. Objective: To evaluate, using TEE, the possibility of characterizing LAA and to analyze its morphological aspects using the CHA2DS2VASc score. Methodology: A total of 247 patients were divided into three groups considering the CHA2DS2-VASc score: Group 1: 0 and 1; Group 2: 2 and 3 and, Group 3: ≥ 4 points. TEE produced the echocardiographic data. LAA was classified into thrombogenic and non-thrombogenic morphologies. In the analysis of statistical tests, a significance level of 5% was adopted. Results: The average age was 50 and 16.2% presented AF. In Group 1, we observed normal variables with a lower prevalence of AF (8.7%, p < 0.001). In group 2, spontaneous contrast was detected in 26.7%, (p < 0.001), thrombus in 6.7% (p = 0.079) and flow velocity in LAA < 0.4 m/s in 22.7% (p < 0.001) of the cases. Group 3 presented the highest percentages of AF (31.8%, p < 0.001), stroke/TIA (77.3%, p < 0.001), EF < 55% (18.2%, p = 0.010) and higher prevalence of thrombogenic type LAA (72.7%, p = 0.014). A higher occurrence of stroke/TIA was observed in patients with thrombogenic LAA (25.2%) compared to the non-thrombogenic group (11.2%), (p = 0.005). Conclusions: The thrombogenic morphology of LAA identified in TEE presented a higher risk of stroke regardless of the CHA2DS2VASc score. Patients with higher scores had greater abnormalities in echocardiographic variables.

Highlights

Stroke is the leading cause of death in Brazil and the heart is an important embolic source responsible for this complication
Group 3 presented the highest percentages of atrial fibrillation (AF) (31.8%, p < 0.001), stroke/TIA (77.3%, p < 0.001), EF < 55% (18.2%, p = 0.010) and higher prevalence of thrombogenic type left atrial appendage (LAA) (72.7%, p = 0.014)
A higher occurrence of stroke/TIA was observed in patients with thrombogenic LAA (25.2%) compared to the non-thrombogenic group (11.2%), (p = 0.005)

Summary

Introduction

Stroke is the leading cause of death in Brazil and the heart is an important embolic source responsible for this complication. Atrial fibrillation accounts for 20% of stroke cases. The treatment of this arrhythmia is an important challenge for the medical community. In addition to reestablishing sinus rhythm or not, or only performing ventricular rate control, anticoagulant therapy is definitely the one that improves the prognosis of affected patients.[1,2] The recommendation of anticoagulation is objectively performed by characterizing the individual risk of systemic thromboembolism based on the CHA2DS2VASc score (C = heart failure; H = hypertension; A = age > 75 years; D = diabetes mellitus; S = history of stroke; V = peripheral vascular disease; A = age above 64 years; S = female sex). In atrial fibrillation (AF), the CHA2DS2-VASc score calculates the risk for stroke. Transesophageal echocardiography (TEE) evaluates LAA and is a more widespread technique

Methods

Results

Discussion

Conclusion