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CHADS(2) score is predictive of left atrial thrombus on precardioversion transesophageal echocardiography in atrial fibrillation.
MedLine Citation:
PMID:  22254195     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The goals of this study were to determine: 1) if the CHADS(2) score correlates with left atrial (LA) or left atrial appendage (LAA) thrombus on pre-cardioversion transesophageal echocardiography (TEE) in nonvalvular atrial fibrillation (NVAF); and 2) what, if any, components of the CHADS(2) score are most important in predicting LA/LAA thrombus.
BACKGROUND: It is unknown if CHADS(2) score, a marker of thromboembolic risk in NVAF, accurately predicts LA/LAA thrombus on pre-cardioversion TEE.
METHODS: We retrospectively studied patients undergoing precardioversion TEE for NVAF at a tertiary hospital. TEE reports were reviewed for presence of LA/LAA thrombus. Using medical records and an ICD-9 coding database, a CHADS(2) score was derived, and the association between CHADS(2) and thrombus was evaluated with Mantel-Haenszel Chi-Square. The relation between the singular components of CHADS(2) and thrombus were analyzed using Pearson's Chi-Square.
RESULTS: In 643 consecutive patients undergoing pre-cardioversion TEE, LA/LAA thrombus was identified in 46 (7.2 %). A strong association was present between CHADS(2)score and LA/LAA thrombus (p = 0.0005). No thrombi were identified in patients with CHADS(2) = 0. Among 46 patients with thrombus, all (100%) had CHF. Of the singular components, CHF was the only factor independently associated with thrombus (p < 0.0001).
CONCLUSIONS: In non-valvular atrial fibrillation, CHADS(2) is strongly associated with LA thrombus on TEE. Our findings suggest pre-cardioversion TEE may be unnecessary if the CHADS(2) score = 0. Of the components of the CHADS(2) score, CHF was the only independently associated risk factor which correlated with LA/LAA thrombus.
Authors:
Jeffrey M Decker; Ryan D Madder; Leaden Hickman; Victor Marinescu; Anna Marandici; Shaheena Raheem; Lynn M Carlyle; Richard Van Dam; Judith A Boura; David E Haines
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Publication Detail:
Type:  Journal Article     Date:  2011-07-28
Journal Detail:
Title:  American journal of cardiovascular disease     Volume:  1     ISSN:  2160-200X     ISO Abbreviation:  Am J Cardiovasc Dis     Publication Date:  2011  
Date Detail:
Created Date:  2012-01-18     Completed Date:  2012-10-02     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  101569582     Medline TA:  Am J Cardiovasc Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  159-65     Citation Subset:  -    
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