Objectives The aims of this study were to evaluate the relationship of the CHADS2 and CHA2DS2-VASc scores with left atrial(LA) thrombus detected by transesophageal echocardiographic and to compare the two risk stratification schemes with respect to their ability to predict LA thrombus in Chinese patients with nonvalvular atrial fibrillation.
Methods Transesophageal echocardiograms of 1544 patients (mean age 57.1 ± 11.9 years; 32% female; 1297 paroxysmal AF) with nonvalvular atrial fibrillation were retrospectively reviewed for LA thrombus. The patients CHADS2 and CHA2DS2-VASc risk scores and categories were also calculated.
Results Transesophageal echocardiography revealed LA thrombi in 53(3.4%) patients. Using CHADS2, LA thrombus was found in 2.7% of the low-risk group, 4.4% of the intermediate-risk group and 3.7% of the high-risk group (p = 0.26). Using CHA2DS2-VASc, LA thrombus was found in 2.3% of the low-risk group, 3.9% of the intermediate-risk group and 3.7% of the high-risk group (p = 0.24). The frequency of patients with LA thrombi fell into the low–intermediate-risk group classified based on the CHADS2 and CHA2DS2-VASc score were 85.0% and 56.6%, respectively. The c-statistics for predicting LA thrombi with CHADS2 and CHA2DS2-VASc were 0.55 (95% CI: 0.473-0.628) and 0.55 (95% CI: 0.477-0.623), respectively.
Conclusions Both CHA2DS2-VASc and CHADS2 scores may have limited value for predict LA thrombus in Chinese patients with nonvalvular atrial fibrillation. Further research is needed to examine their true predictive value.