Additional value of left atrial appendage geometry and hemodynamics when considering anticoagulation strategy in patients with atrial fibrillation with low CHA(2)DS(2)-VASc scores

作者：Lee Jung Myung; Kim Jin Bae; Uhm Jae Sun; Pak Hui Nam; Lee Moon Hyoung; Joung Boyoung

来源：Heart Rhythm, 2017, 14(9): 1297-1301.

DOI：10.1016/j.hrthm.2017.05.034

• Left atrial appendage size
• Flow velocity
• Atrial fibrillation
• Risk factors for stroke
• Low CHA(2)DS(2)-VASc score

BACKGROUND Strokes occur in some patients with atrial fibrillation (AF), even when the CHA(2)DS(2)-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 CHA(2)DS(2)-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 CHA(2)DS(2)-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 cm(2) vs 2.83 +/- 0.9 cm(2); 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 cm(2)) were independent predictors of stroke. Patients with an LAA flow velocity of < 40 cm/s and an LAA orifice of > 4.0 cm(2) 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.
CONCLUSION Even in patients with low CHA(2)DS(2)-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.

• 出版日期2017-9