Department of Internal Medicine, Hebei Medical University, No. 361 Zhongshan East Road, Shijiazhuang, 050017, China.
Department of Cardiology, Cangzhou Central Hospital, No. 16 Xinhua Road, Yunhe Qu, Cangzhou City, 061000, China.
J Interv Card Electrophysiol. 2022 Nov;65(2):535-542. doi: 10.1007/s10840-022-01285-y. Epub 2022 Jul 13.
CHADS-VASc-RAF (R is renal dysfunction, and AF is atrial fibrillation type) and CHADS-VASc-LAF (L is left atrial diameter, and AF is atrial fibrillation type) scores have been developed to estimate the risk of left atrial thrombus (LAT) and spontaneous echo contrast (SEC) in patients with non-valvular atrial fibrillation (NVAF). However, few external validations have been conducted to assess their accuracy. Thus, this study aimed to validate and compare the two modified scores for predicting LAT/SEC in patients with NVAF.
This study included 399 patients with NVAF who underwent transesophageal echocardiography. Risk factors related to LAT/SEC were identified through logistic regression analysis, and predictive value and diagnostic efficiency were evaluated using receiver operating characteristic (ROC) curve.
Approximately 9.8% (39/399) of the patients with NVAF had LAT/SEC. Multivariate logistic regression analysis showed that history of stroke/transient ischemic attack, congestive heart failure, non-paroxysmal atrial fibrillation, lack of anticoagulation therapy, enlarged left atrial diameter, enlarged left ventricular end diastolic diameter, decreased left ventricular ejection fraction, decreased left atrial appendage emptying velocity, and decreased estimated glomerular filtration rate were independent risk factors for LAT/SEC. The CHADS-VASc-LAF (area under the ROC curve [AUC] = 0.839) and CHADS-VASc-RAF (AUC = 0.829) scores showed larger predictive values than the CHADS-VASc (AUC = 0.737) and CHADS (AUC = 0.736) scores. The AUC of the CHADS-VASc-RAF score was similar to that of the CHADS-VASc-LAF score (Z = 0.432; P = 0.666).
This study validated that the CHADS-VASc-RAF and CHADS-VASc-LAF scores are useful prognostic scoring systems for predicting LAT/SEC in patients with NVAF.
CHADS-VASc-RAF（R 代表肾功能障碍，AF 代表心房颤动类型）和 CHADS-VASc-LAF（L 代表左心房直径，AF 代表心房颤动类型）评分用于评估非瓣膜性心房颤动（NVAF）患者左心房血栓（LAT）和自发性回声对比（SEC）的风险。然而，很少有外部验证来评估其准确性。因此，本研究旨在验证和比较两种改良评分在预测 NVAF 患者 LAT/SEC 中的准确性。
本研究纳入 399 例接受经食管超声心动图检查的 NVAF 患者。通过逻辑回归分析确定与 LAT/SEC 相关的危险因素，并通过接收者操作特征（ROC）曲线评估预测值和诊断效率。
约 9.8%（39/399）的 NVAF 患者存在 LAT/SEC。多变量逻辑回归分析显示，既往卒中/短暂性脑缺血发作、充血性心力衰竭、非阵发性心房颤动、缺乏抗凝治疗、左心房增大、左心室舒张末期直径增大、左心室射血分数降低、左心耳排空速度降低和估计肾小球滤过率降低是 LAT/SEC 的独立危险因素。CHADS-VASc-LAF（ROC 曲线下面积 [AUC] = 0.839）和 CHADS-VASc-RAF（AUC = 0.829）评分的预测值均大于 CHADS-VASc（AUC = 0.737）和 CHADS（AUC = 0.736）评分。CHADS-VASc-RAF 评分的 AUC 与 CHADS-VASc-LAF 评分相似（Z = 0.432；P = 0.666）。
本研究验证了 CHADS-VASc-RAF 和 CHADS-VASc-LAF 评分是预测 NVAF 患者 LAT/SEC 的有用预后评分系统。
