Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.
Am J Cardiol. 2013 Sep 1;112(5):678-83. doi: 10.1016/j.amjcard.2013.04.047. Epub 2013 May 29.
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.
CHADS₂ 评分系统被发现是预测房颤患者中风风险的良好指标。该评分系统在评估直流电复律前血栓形成环境方面的有效性尚未在大规模研究中得到充分证实。在这项研究中，分析了 1999 年至 2008 年间因直流电复律而进行经食管超声心动图筛查的 2369 例连续患者的数据。研究了左心房（LA）或 LA 附属物（LAA）血栓形成环境（自发性回声对比、淤泥和血栓）。结果与 CHADS₂ 评分结果相关。平均年龄为 66±13 岁，男女比例为 2.2:1。CHADS₂ 评分为 0、1、2、3、4、5 和 6 的分别占研究的 11%、25%、30%、22%、8%、3%和 1%。LA 或 LAA 淤泥或血栓的患病率随 CHADS₂ 评分的增加而增加（评分分别为 0、1、2、3、4 和 5 或 6 的患者的 LA 或 LAA 淤泥或血栓的患病率分别为 2.3%、7%、8.5%、9.9%、12.3%和 14.1%，p=0.01）。在多变量模型中，射血分数≤20%是 LA 或 LAA 淤泥或血栓的最佳预测指标（比值比 2.99，p<0.001）。总之，接受经食管超声心动图引导的直流电复律的患者中，血栓形成环境的经食管超声心动图标志物与 CHADS₂ 评分的增加高度相关。更重视超声心动图检查结果，如左心室射血分数及其不同水平（尤其是射血分数≤20%），可能会提高 CHADS₂ 评分方案预测房颤患者左心房或 LAA 血栓形成环境的准确性，以替代心源性栓塞风险。
