Correlation of CHADS2 and CHA2DS2-VASc scores with transesophageal echocardiography risk factors for thromboembolism in a multiethnic united states population with nonvalvular atrial fibrillation

Howard J. Willens, Orlando W Gomez-Marin, Katarina Nelson, Andrew Denicco, Mauro Moscucci

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background: The aims of this study were to evaluate the relationship of the CHA2DS2-VASc score and risk categories with transesophageal echocardiographic (TEE) risk factors for thromboembolism and to compare the CHA2DS2-VASc and CHADS2 risk stratification schemes with respect to their ability to predict these risk factors in a multiethnic US population with nonvalvular atrial fibrillation. Methods: Transesophageal echocardiograms of 167 patients (mean age, 66.3 ± 11.6 years; 146 men [87%]; 100 whites [60%]; 40 Hispanics [24%]; 27 blacks [16%]) with nonvalvular atrial fibrillation were retrospectively reviewed for smoke, sludge, thrombus, and left atrial appendage (LAA) emptying velocity ≤20 cm/sec. The patients' CHA2DS2-VASc and CHADS 2 risk scores and categories were also calculated. Results: Any LAA abnormality, smoke, sludge, thrombus, and abnormal LAA emptying velocity were present in 45%, 38%, 13%, 3%, and 22% of patients, respectively. Heart failure (P < .001), age (P < .001 for age ≥75 vs ≤64 years, P = .013 for age 65-74 vs ≤64 years), and diabetes (P = .019) were independent predictors of LAA abnormalities, while ethnicity was not. The prevalence of TEE risk factors for thromboembolism increased with increasing CHA2DS2-VASc score and risk category. The CHADS2 risk categories of 35 patients (21%) were upgraded by the CHA2DS2-VASc scheme. Using the latter scheme, fewer patients were classified as at intermediate risk compared with the CHADS2 system (21 [13%] vs 46 [28%]). Patients classified as at low risk by either scheme had almost no TEE risk factors. Of 30 intermediate-risk patients by CHADS2 score upgraded to high risk using CHA2DS2-VASc score, eight (27%) had at least one TEE risk factor for thromboembolism. C-statistics, sensitivity, and specificity for predicting any LAA abnormality were 0.607 (95% confidence interval, 0.549-0.665), 92.0%, and 28.9% for CHA2DS2-VASc score and 0.685 (95% confidence interval, 0.615-0.755), 81.3%, and 54.2% for CHADS 2 score. Conclusions: CHA2DS2-VASc score is associated with TEE risk factors for thromboembolism in a multiethnic US population. Compared with CHADS2 score, it has increased sensitivity, decreased specificity, and lower ability for predicting TEE risk factors in this population.

Original languageEnglish
Pages (from-to)175-184
Number of pages10
JournalJournal of the American Society of Echocardiography
Volume26
Issue number2
DOIs
StatePublished - Feb 1 2013

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Thromboembolism
Transesophageal Echocardiography
Atrial Fibrillation
Atrial Appendage
Population
Sewage
Smoke
Thrombosis
Confidence Intervals
Sensitivity and Specificity
Hispanic Americans
Heart Failure

Keywords

  • Atrial fibrillation
  • CHADS-VASc score
  • CHADS score
  • Left atrium
  • Transesophageal echocardiography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Correlation of CHADS2 and CHA2DS2-VASc scores with transesophageal echocardiography risk factors for thromboembolism in a multiethnic united states population with nonvalvular atrial fibrillation. / Willens, Howard J.; Gomez-Marin, Orlando W; Nelson, Katarina; Denicco, Andrew; Moscucci, Mauro.

In: Journal of the American Society of Echocardiography, Vol. 26, No. 2, 01.02.2013, p. 175-184.

Research output: Contribution to journalArticle

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title = "Correlation of CHADS2 and CHA2DS2-VASc scores with transesophageal echocardiography risk factors for thromboembolism in a multiethnic united states population with nonvalvular atrial fibrillation",
abstract = "Background: The aims of this study were to evaluate the relationship of the CHA2DS2-VASc score and risk categories with transesophageal echocardiographic (TEE) risk factors for thromboembolism and to compare the CHA2DS2-VASc and CHADS2 risk stratification schemes with respect to their ability to predict these risk factors in a multiethnic US population with nonvalvular atrial fibrillation. Methods: Transesophageal echocardiograms of 167 patients (mean age, 66.3 ± 11.6 years; 146 men [87{\%}]; 100 whites [60{\%}]; 40 Hispanics [24{\%}]; 27 blacks [16{\%}]) with nonvalvular atrial fibrillation were retrospectively reviewed for smoke, sludge, thrombus, and left atrial appendage (LAA) emptying velocity ≤20 cm/sec. The patients' CHA2DS2-VASc and CHADS 2 risk scores and categories were also calculated. Results: Any LAA abnormality, smoke, sludge, thrombus, and abnormal LAA emptying velocity were present in 45{\%}, 38{\%}, 13{\%}, 3{\%}, and 22{\%} of patients, respectively. Heart failure (P < .001), age (P < .001 for age ≥75 vs ≤64 years, P = .013 for age 65-74 vs ≤64 years), and diabetes (P = .019) were independent predictors of LAA abnormalities, while ethnicity was not. The prevalence of TEE risk factors for thromboembolism increased with increasing CHA2DS2-VASc score and risk category. The CHADS2 risk categories of 35 patients (21{\%}) were upgraded by the CHA2DS2-VASc scheme. Using the latter scheme, fewer patients were classified as at intermediate risk compared with the CHADS2 system (21 [13{\%}] vs 46 [28{\%}]). Patients classified as at low risk by either scheme had almost no TEE risk factors. Of 30 intermediate-risk patients by CHADS2 score upgraded to high risk using CHA2DS2-VASc score, eight (27{\%}) had at least one TEE risk factor for thromboembolism. C-statistics, sensitivity, and specificity for predicting any LAA abnormality were 0.607 (95{\%} confidence interval, 0.549-0.665), 92.0{\%}, and 28.9{\%} for CHA2DS2-VASc score and 0.685 (95{\%} confidence interval, 0.615-0.755), 81.3{\%}, and 54.2{\%} for CHADS 2 score. Conclusions: CHA2DS2-VASc score is associated with TEE risk factors for thromboembolism in a multiethnic US population. Compared with CHADS2 score, it has increased sensitivity, decreased specificity, and lower ability for predicting TEE risk factors in this population.",
keywords = "Atrial fibrillation, CHADS-VASc score, CHADS score, Left atrium, Transesophageal echocardiography",
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T1 - Correlation of CHADS2 and CHA2DS2-VASc scores with transesophageal echocardiography risk factors for thromboembolism in a multiethnic united states population with nonvalvular atrial fibrillation

AU - Willens, Howard J.

AU - Gomez-Marin, Orlando W

AU - Nelson, Katarina

AU - Denicco, Andrew

AU - Moscucci, Mauro

PY - 2013/2/1

Y1 - 2013/2/1

N2 - Background: The aims of this study were to evaluate the relationship of the CHA2DS2-VASc score and risk categories with transesophageal echocardiographic (TEE) risk factors for thromboembolism and to compare the CHA2DS2-VASc and CHADS2 risk stratification schemes with respect to their ability to predict these risk factors in a multiethnic US population with nonvalvular atrial fibrillation. Methods: Transesophageal echocardiograms of 167 patients (mean age, 66.3 ± 11.6 years; 146 men [87%]; 100 whites [60%]; 40 Hispanics [24%]; 27 blacks [16%]) with nonvalvular atrial fibrillation were retrospectively reviewed for smoke, sludge, thrombus, and left atrial appendage (LAA) emptying velocity ≤20 cm/sec. The patients' CHA2DS2-VASc and CHADS 2 risk scores and categories were also calculated. Results: Any LAA abnormality, smoke, sludge, thrombus, and abnormal LAA emptying velocity were present in 45%, 38%, 13%, 3%, and 22% of patients, respectively. Heart failure (P < .001), age (P < .001 for age ≥75 vs ≤64 years, P = .013 for age 65-74 vs ≤64 years), and diabetes (P = .019) were independent predictors of LAA abnormalities, while ethnicity was not. The prevalence of TEE risk factors for thromboembolism increased with increasing CHA2DS2-VASc score and risk category. The CHADS2 risk categories of 35 patients (21%) were upgraded by the CHA2DS2-VASc scheme. Using the latter scheme, fewer patients were classified as at intermediate risk compared with the CHADS2 system (21 [13%] vs 46 [28%]). Patients classified as at low risk by either scheme had almost no TEE risk factors. Of 30 intermediate-risk patients by CHADS2 score upgraded to high risk using CHA2DS2-VASc score, eight (27%) had at least one TEE risk factor for thromboembolism. C-statistics, sensitivity, and specificity for predicting any LAA abnormality were 0.607 (95% confidence interval, 0.549-0.665), 92.0%, and 28.9% for CHA2DS2-VASc score and 0.685 (95% confidence interval, 0.615-0.755), 81.3%, and 54.2% for CHADS 2 score. Conclusions: CHA2DS2-VASc score is associated with TEE risk factors for thromboembolism in a multiethnic US population. Compared with CHADS2 score, it has increased sensitivity, decreased specificity, and lower ability for predicting TEE risk factors in this population.

AB - Background: The aims of this study were to evaluate the relationship of the CHA2DS2-VASc score and risk categories with transesophageal echocardiographic (TEE) risk factors for thromboembolism and to compare the CHA2DS2-VASc and CHADS2 risk stratification schemes with respect to their ability to predict these risk factors in a multiethnic US population with nonvalvular atrial fibrillation. Methods: Transesophageal echocardiograms of 167 patients (mean age, 66.3 ± 11.6 years; 146 men [87%]; 100 whites [60%]; 40 Hispanics [24%]; 27 blacks [16%]) with nonvalvular atrial fibrillation were retrospectively reviewed for smoke, sludge, thrombus, and left atrial appendage (LAA) emptying velocity ≤20 cm/sec. The patients' CHA2DS2-VASc and CHADS 2 risk scores and categories were also calculated. Results: Any LAA abnormality, smoke, sludge, thrombus, and abnormal LAA emptying velocity were present in 45%, 38%, 13%, 3%, and 22% of patients, respectively. Heart failure (P < .001), age (P < .001 for age ≥75 vs ≤64 years, P = .013 for age 65-74 vs ≤64 years), and diabetes (P = .019) were independent predictors of LAA abnormalities, while ethnicity was not. The prevalence of TEE risk factors for thromboembolism increased with increasing CHA2DS2-VASc score and risk category. The CHADS2 risk categories of 35 patients (21%) were upgraded by the CHA2DS2-VASc scheme. Using the latter scheme, fewer patients were classified as at intermediate risk compared with the CHADS2 system (21 [13%] vs 46 [28%]). Patients classified as at low risk by either scheme had almost no TEE risk factors. Of 30 intermediate-risk patients by CHADS2 score upgraded to high risk using CHA2DS2-VASc score, eight (27%) had at least one TEE risk factor for thromboembolism. C-statistics, sensitivity, and specificity for predicting any LAA abnormality were 0.607 (95% confidence interval, 0.549-0.665), 92.0%, and 28.9% for CHA2DS2-VASc score and 0.685 (95% confidence interval, 0.615-0.755), 81.3%, and 54.2% for CHADS 2 score. Conclusions: CHA2DS2-VASc score is associated with TEE risk factors for thromboembolism in a multiethnic US population. Compared with CHADS2 score, it has increased sensitivity, decreased specificity, and lower ability for predicting TEE risk factors in this population.

KW - Atrial fibrillation

KW - CHADS-VASc score

KW - CHADS score

KW - Left atrium

KW - Transesophageal echocardiography

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