AlKharji Samah, Al Rawahi Mohamed, AlTurki Ahmed, Thanassoulis George, Bernier Martin L, Huynh Thao, Essebag Vidal, Joza Jacqueline
Division of Cardiology, McGill University Health Centre Montreal, Quebec, Canada.
Research Institute of McGill University Health Centre Montreal, Quebec, Canada.
Arrhythm Electrophysiol Rev. 2025 Aug 26;14:e19. doi: 10.15420/aer.2025.02. eCollection 2025.
Elevated CHADS-VASc scores are considered to be predictors of left atrial appendage (LAA) thrombus (LAAT); however, individuals with low scores remain at risk. Studies have indicated that aortic atherosclerosis (AA) is associated with increased stroke risk. AA on transoesophageal echocardiography (TOE) has been overlooked as a 'vascular' variable in the CHADS-VASc score.
Determine the prevalence of LAAT in patients with low thromboembolic risk and the correlation of AA with LAAT.
We performed a retrospective review of all TOEs performed for patients who underwent electrophysiology procedures at the McGill University Health Centre from 2012 to 2017 and collected pertinent clinical and echocardiography variables. We reviewed all TOEs to evaluate the presence and severity of AA using the Katz score, American Society of Echocardiography (ASE) grade and the Ferrari score. In patients with a CHADS of 0 and CHADS-VASc score of ≤1, logistical regression and receiver operating characteristic curves were used to identify predictors for LAAT.
592 patients underwent a pre-procedure TOE and were included in the analysis. Among 249 patients with CHADS-VASc scores ≤1, 7.5% had LAA. AA burden by Katz score was an independent predictor of LAAT (area under the curve (AUC) 0.76 95% CI [0.60-0.92]) for CHADS-VASc ≤1.
AA visualised on TOE was significantly associated with an increased risk of LAAT development in patients with low CHADS-VASc scores. Incorporating AA assessment into risk stratification may enhance clinical decision-making for the use of anticoagulation for patients with AF. Future studies are warranted to evaluate the use of other imaging modalities for AA detection.
CHADS-VASc评分升高被认为是左心耳（LAA）血栓（LAAT）的预测指标；然而，评分低的个体仍有风险。研究表明，主动脉粥样硬化（AA）与中风风险增加有关。经食管超声心动图（TOE）检查发现的AA在CHADS-VASc评分中作为一个“血管”变量被忽视了。
确定低血栓栓塞风险患者中LAAT的患病率以及AA与LAAT的相关性。
我们对2012年至2017年在麦吉尔大学健康中心接受电生理手术的患者所做的所有TOE检查进行了回顾性分析，并收集了相关的临床和超声心动图变量。我们复查了所有TOE检查结果，使用Katz评分、美国超声心动图学会（ASE）分级和Ferrari评分来评估AA的存在情况和严重程度。对于CHADS为0且CHADS-VASc评分为≤1的患者，采用逻辑回归和受试者操作特征曲线来确定LAAT的预测因素。
592例患者在术前接受了TOE检查并纳入分析。在CHADS-VASc评分≤1的249例患者中，7.5%有LAA。对于CHADS-VASc≤1的患者，Katz评分的AA负荷是LAAT的独立预测因素（曲线下面积（AUC）0.76，95%可信区间[0.60-0.92]）。
TOE显示的AA与CHADS-VASc评分低的患者发生LAAT的风险增加显著相关。将AA评估纳入风险分层可能会增强房颤患者抗凝治疗的临床决策。有必要进行进一步研究以评估使用其他成像方式检测AA的情况。
