External validation and comparison of CHADS-VASc-RAF and CHADS-VASc-LAF scores for predicting left atrial thrombus and spontaneous echo contrast in patients with non-valvular atrial fibrillation.

PURPOSE

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.

METHODS

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.

RESULTS

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).

CONCLUSION

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.