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Additional value of left atrial appendage geometry and hemodynamics when considering anticoagulation strategy in patients with atrial fibrillation with low CHA2DS2-VASc scores

 Jung Myung Lee MD  ;  Jin-Bae Kim  ;  Jae-Sun Uhm  ;  Hui-Nam Pak  ;  Moon-Hyoung Lee  ;  Boyoung Joung 
 HEART RHYTHM, Vol.14(9) : 1297-1301, 2017 
Journal Title
Issue Date
Aged ; Anticoagulants/therapeutic use* ; Atrial Appendage/diagnostic imaging* ; Atrial Fibrillation/drug therapy ; Atrial Fibrillation/physiopathology* ; Atrial Fibrillation/surgery ; Brain/diagnostic imaging ; Brain Ischemia/epidemiology ; Brain Ischemia/etiology ; Brain Ischemia/prevention & control* ; Catheter Ablation ; Echocardiography, Transesophageal ; Female ; Follow-Up Studies ; Hemodynamics/physiology* ; Humans ; Incidence ; Male ; Middle Aged ; Multidetector Computed Tomography ; Prognosis ; Prospective Studies ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Assessment* ; Risk Factors
Atrial fibrillation ; Flow velocity ; Left atrial appendage size ; Low CHA(2)DS(2)-VASc score ; Risk factors for stroke
BACKGROUND: Strokes occur in some patients with atrial fibrillation (AF), even when the CHA2DS2-VASc (congestive heart failure, hypertension, age >75 years, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age>65 years, female sex) score is low.

OBJECTIVE: We sought to determine the factors defining the residual stroke risk in patients with AF and low CHA2DS2-VASc scores, with a particular focus on the hemodynamics and geometry of the left atrial appendage (LAA).

METHODS: From February 1, 2008 to December 31, 2012, 66 consecutive patients with nonvalvular AF and a CHA2DS2-VASc score of 0 or 1 (except a point for the female sex) were enrolled. All patients were admitted with a diagnosis of acute ischemic stroke. The control group consisted of patients with nonvalvular AF without a history of stroke.

RESULTS: The LAA orifice area was larger (4.35 ± 1.51 cm2 vs 2.83 ± 0.9 cm2; P < .001) and the LAA flow velocity was lower (41.9 ± 22.7 cm/s vs 54.4 ± 19.9 cm/s; P < .001) in the stroke group than in the control group. Low LAA flow velocity (<40 cm/s) and large LAA orifice area (>4 cm2) were independent predictors of stroke. Patients with an LAA flow velocity of <40 cm/s and an LAA orifice of >4.0 cm2 had a markedly higher odds ratio (odds ratio 10.9; 95% confidence interval 3.0-40.0; P < .001) of stroke than did those with preserved LAA flow velocity and smaller LAA orifice.CLUSION:

Even in patients with low CHA2DS2-VASc scores, the presence of both decreased LAA flow velocity and increased LAA orifice size was associated with a high odds ratio of stroke. Future large prospective studies are needed to assess whether these patients should receive anticoagulants.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Uhm, Jae Sun(엄재선) ORCID logo https://orcid.org/0000-0002-1611-8172
Lee, Moon-Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
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