International Journal of Cardiovascular Sciences. 01/out/2019;32(5):460-70.

Association between Morphodynamic Variables by Transesophageal Echocardiography and CHA₂DS₂-Vasc Values

Renata Rejane Linhares, Dalmo Antonio Ribeiro Moreira, Luciana Braz Peixoto, Andresa Paes da Cruz, Luara Piovam Garcia, Rodrigo Bellio de Mattos Barretto, David Costa de Souza Le Bihan, Carlos Eduardo Suaide Silva

DOI: 10.5935/2359-4802.20190017

Este Artigo Original é referido pelo Editorial "Risk Scores for Stroke Prevention in Patients with Non-Valvular Atrial Prevention: Is it Time to Put Parameters of Left Atrial Appendage Morphology and Function Into Clinical Practice?".

Background:

In atrial fibrillation (AF), the CHA2DS2-VASc score calculates the risk for stroke. Di Biase classified the left atrial appendage (LAA), using magnetic resonance imaging, into 4 morphological types and correlated it with cerebrovascular events. Transesophageal echocardiography (TEE) also evaluates LAA and is a more widespread technique.

Objective:

To evaluate, using TEE, the possibility of characterizing LAA and to analyze its morphological aspects using the CHA2DS2VASc score.

Methodology:

A total of 247 patients were divided into three groups considering the CHA2DS2-VASc score: Group 1: 0 and 1; Group 2: 2 and 3 and, Group 3: ? 4 points. TEE produced the echocardiographic data. LAA was classified into thrombogenic and non-thrombogenic morphologies. In the analysis of statistical tests, a significance level of 5% was adopted.

Results:

The average age was 50 and 16.2% presented AF. In Group 1, we observed normal variables with a lower prevalence of AF (8.7%, p < 0.001). In group 2, spontaneous contrast was detected in 26.7%, (p < 0.001), thrombus in 6.7% (p = 0.079) and flow velocity in LAA < 0.4 m/s in 22.7% (p < 0.001) of the cases. Group 3 presented the highest percentages of AF (31.8%, p < 0.001), stroke/TIA (77.3%, p < 0.001), EF < 55% (18.2%, p = 0.010) and higher prevalence of thrombogenic type LAA (72.7%, p = 0.014). A higher occurrence of stroke/TIA was observed in patients with thrombogenic LAA (25.2%) compared to the non-thrombogenic group (11.2%), (p = 0.005).

Conclusions:

The thrombogenic morphology of LAA identified in TEE presented a higher risk of stroke regardless of the CHA2DS2VASc score. Patients with higher scores had greater abnormalities in echocardiographic variables.