Department of Internal Medicine, Section of Cardiology, Electrophysiology, Arrhythmia, Pacemaker Services, Rush University Medical Center, Chicago, Illinois, USA.
Am J Cardiol. 2012 Feb 15;109(4):550-5. doi: 10.1016/j.amjcard.2011.10.007. Epub 2011 Nov 29.
The CHA(2)DS(2)-VASc and CHADS(2) risk stratification schemes are used to predict thromboembolism and ischemic stroke in patients with atrial fibrillation. However, limited data are available regarding the utility of these risk stratification schemes for stroke in patients with atrial flutter. A retrospective analysis of 455 transesophageal echocardiographic studies in patients with atrial flutter was performed to identify left atrial (LA) thrombi and/or spontaneous echocardiographic contrast (SEC). The CHA(2)DS(2)-VASc (Congestive heart failure, Hypertension, Age ≥75 years [doubled risk weight], Diabetes mellitus, previous Stroke/transient ischemic attack [doubled risk weight], Vascular disease, Age 65 to 74 years, Sex) and CHADS(2) (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, previous Stroke/transient ischemic attack [double risk weight]) scores were calculated to stratify the risk of stroke or transient cerebrovascular ischemic events. Transesophageal echocardiography revealed LA thrombi in 5.3% and SEC in 25.9% of patients. Using CHADS(2), LA thrombus was found in 2.2% of the low-intermediate-risk group and 8.3% of the high-risk group (p = 0.005). SEC was found in 19.8% of the low-intermediate-risk group and 32% of the high-risk group (p = 0.004). Using CHA(2)DS(2)-VASc, LA thrombus was found in 1.7% of the low-intermediate-risk group and 6.5% of the high-risk group (p = 0.053). SEC was found in 11.8% of the low-intermediate-risk group versus 30.9% of the high-risk group (p = 0.004). The sensitivity for LA thrombus/SEC with a high CHADS(2) and CHA(2)DS(2)-VASc score was 64.8% and 88.7%, respectively (p = 0.0001). The specificity for LA thrombus/SEC with high CHADS(2) and CHA(2)DS(2)-VASc scores was 52.6% and 28.9%, respectively (p = 0.0001). In conclusion, both CHA(2)DS(2)-VASc and CHADS(2) scores are useful for stroke risk stratification in patients with atrial flutter. CHA(2)DS(2)-VASc had greater sensitivity for LA thrombus and SEC detection at the cost of reduced specificity.
CHA(2)DS(2)-VASc 和 CHADS(2) 风险分层方案用于预测心房颤动患者的血栓栓塞和缺血性卒中。然而，关于这些风险分层方案在心房扑动患者卒中中的应用，相关数据有限。对 455 例接受经食管超声心动图检查的心房扑动患者进行了回顾性分析，以确定左心房（LA）血栓和/或自发性超声对比（SEC）。计算 CHA(2)DS(2)-VASc（充血性心力衰竭、高血压、年龄≥75 岁[风险权重加倍]、糖尿病、既往卒中和短暂性脑缺血发作[风险权重加倍]、血管疾病、年龄 65 至 74 岁、性别）和 CHADS(2)（充血性心力衰竭、高血压、年龄≥75 岁、糖尿病、既往卒中和短暂性脑缺血发作[风险权重加倍]）评分，以分层卒中或短暂性脑缺血事件风险。经食管超声心动图显示，5.3%的患者存在 LA 血栓，25.9%的患者存在 SEC。使用 CHADS(2)，低危-中危组中有 2.2%的患者和高危组中有 8.3%的患者存在 LA 血栓（p=0.005）。SEC 在低危-中危组中发现 19.8%，高危组中发现 32%（p=0.004）。使用 CHA(2)DS(2)-VASc，低危-中危组中有 1.7%的患者和高危组中有 6.5%的患者存在 LA 血栓（p=0.053）。SEC 在低危-中危组中发现 11.8%，高危组中发现 30.9%（p=0.004）。高 CHADS(2)和 CHA(2)DS(2)-VASc 评分对 LA 血栓/SEC 的敏感性分别为 64.8%和 88.7%（p=0.0001）。高 CHADS(2)和 CHA(2)DS(2)-VASc 评分对 LA 血栓/SEC 的特异性分别为 52.6%和 28.9%（p=0.0001）。总之，CHA(2)DS(2)-VASc 和 CHADS(2)评分均有助于心房扑动患者的卒中风险分层。CHA(2)DS(2)-VASc 在检测 LA 血栓和 SEC 方面具有更高的敏感性，但特异性降低。
