CHADS2 versus CHA2DS2-VASc scoring systems for predicting left atrial thrombus in patients with nonvalvular atrial fibrillation

GU Jun; JIA Fengpeng; FENG Panpan

doi:10.3969/j.issn.1673-4254.2014.11.09

Abstract：Objective To assess the correlation of CHADS2 and CHA2DS2-VASc scores for left atrial thrombus in patients with nonvalvular atrial fibrillation and the differences in the results between the two scoring systems. Methods A total of 397 patients with nonvalvular atrial fibrillation were enrolled in this study. The CHADS2 and CHA2DS2-VASc scoring systems were used for evaluating the risk of left atrial thrombus and their differences in the scores and risk stratifications were compared. The correlation of CHADS2 and CHA2DS2-VASc scores with left atrial thrombus was analyzed. Results The average score of CHA2DS2-VASc was significantly higher than that of CHADS2 in these patients (1.37±1.19 vs 0.63±0.78, P<0.001). The proportion of high-risk group was significantly higher (P<0.001) while that of low-risk group significantly lower as stratified by CHA2DS2-VASc scores than by CHADS2 scores (P<0.001). Transesophageal echocardiography detected left atrial thrombus in 44 of the total patients. The prevalence of left atrial thrombus increased significantly with a higher risk stratification by CHADS2 or CHA2DS2-VASc scores (P<0.05). Univariate analysis showed that female gender, age≥65 years, left atrium diameter≥38 mm, left ventricular ejection fraction ≤40%, hypertension, diabetes, coronary heart disease, stroke history, CHADS2≥2, and CHA2DS2-VASc≥2 were all correlated with left atrial thrombus, but multivariate logistic analysis identified only CHA2DS2-VASc≥2 as the independent risk factor for left atrial thrombus (OR=9.85, 95%CI:2.178-44.542, P<0.01). Conclusion The average score of CHA2DS2-VASc is higher than that of CHADS2 and has better predictive ability for left atrial thrombus.