The CHADS2 scoring system was found to be a good predictor for risk stratification of stroke
in patients with atrial fibrillation. The effectiveness of this scoring system in
assessing thrombogenic milieu before direct-current cardioversion has not yet fully
been established on a large scale. In this study, data from 2,369 consecutive patients
in whom transesophageal echocardiography was performed for screening before direct-current
cardioversion from 1999 to 2008 were analyzed. Left atrial (LA) or LA appendage (LAA)
thrombogenic milieu (spontaneous echo contrast, sludge, and thrombus) was investigated.
The results were correlated with CHADS2 score findings. The mean age was 66 ± 13 years, and the ratio of men to women was
2.2:1. CHADS2 scores of 0, 1, 2, 3, 4, 5 and 6 were present in 11%, 25%, 30%, 22%, 8%, 3%, and
1% of the studies, respectively. The prevalence of LA or LAA sludge or thrombus increased
with increasing CHADS2 scores (2.3%, 7%, 8.5%, 9.9%, 12.3%, and 14.1% for scores of 0, 1, 2, 3, 4, and 5
or 6, respectively, p = 0.01). In a multivariate model, an ejection fraction ≤20%
was the best predictor of LA or LAA sludge or thrombus (odds ratio 2.99, p <0.001).
In conclusion, transesophageal echocardiographic markers of thrombogenic milieu were
highly correlated with increasing CHADS2 scores in patients who underwent transesophageal echocardiography–guided cardioversion.
Giving more value to echocardiographic findings, such as the left ventricular ejection
fraction, and its different levels (especially an ejection fraction ≤20%) might improve
the precision of the CHADS2 scoring scheme to predict thrombogenic milieu in the left atrium or LAA as a surrogate
to cardioembolic risk in patients with atrial fibrillation.
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Article Info
Publication History
Published online: May 31, 2013
Accepted:
April 19,
2013
Received in revised form:
April 19,
2013
Received:
January 30,
2013
Footnotes
See page 682 for disclosure information.
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Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
