Severe Spontaneous Echo Contrast/Auricolar Thrombosis in 'Nonvalvular' AF: Value of Thromboembolic Risk Scores
| Autor: | Rosario Russo, Antonino Pitì, Giosuè Mascioli, Ombretta Ornago, Federica Michelotti, Elena Lucca, Cristina Rota, Carlo Savasta, Giovanni Sirianni, Matteo Pennesi, Giusy Alioto, Guido Belli, Emanuela Pulcini, Franco Santoro |
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| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Framingham Risk Score Ejection fraction medicine.diagnostic_test Receiver operating characteristic business.industry Atrial fibrillation General Medicine 030204 cardiovascular system & hematology Transesophageal echocardiogram medicine.disease Thrombosis 03 medical and health sciences 0302 clinical medicine Internal medicine Heart failure medicine Cardiology 030212 general & internal medicine Risk factor Cardiology and Cardiovascular Medicine business |
| Zdroj: | Pacing and Clinical Electrophysiology. 40:57-62 |
| ISSN: | 0147-8389 |
| DOI: | 10.1111/pace.12958 |
| Popis: | Background Patients with atrial fibrillation (AF) have an increased thromboembolic risk that can be estimated with risk scores and sometimes require oral anticoagulation therapy (OAT). Despite correct anticoagulation, some patients still develop left atrial spontaneous echo contrast (SEC) or thrombosis. The value of traditional risk scores (R2 CHADS2 , CHADS2 , and CHA2 DS2 -VASc) in predicting such events remains controversial. Methods and results The aim of our study was to explore variables linked to severe SEC or atrial thrombosis and evaluate the performance of traditional risk scores in identifying these patients. In order to do this, we retrospectively analyzed 568 patients with nonvalvular nonparoxysmal AF who underwent electrical cardioversion from January 2011 to December 2016 after OAT for a minimum of 4 weeks. A transesophageal echocardiogram was performed in 265 patients for various indications, and 24 exhibited left atrial SEC or thrombosis. Female gender, history of heart failure or left ventricular ejection fraction 1 mg/dL) of C-reactive protein (CRP) were independently associated with left atrial SEC/thrombosis. A score composed by these factors (denominated HIS [Heart Failure, Inflammation, and female Sex]) showed a sensitivity of 79% and a specificity of 60% (area under receiver operating characteristic curve 0.695, P = 0.002) in identifying patients with a positive transesophageal echo; traditional risk scores did not perform as well. Conclusions In patients with persistent AF and suboptimal anticoagulation, a risk score composed by history of heart failure, high CRP, and female gender identifies patients at high risk of left atrial SEC/thrombosis when its value is >1. |
| Databáze: | OpenAIRE |
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