Association between Morphodynamic Variables by Transesophageal Echocardiography and CHA<sub>2</sub>DS<sub>2</sub>-Vasc Values

Linhares, Renata Rejane; Moreira, Dalmo Antonio Ribeiro; Peixoto, Luciana Braz; Cruz, Andresa Paes da; Garcia, Luara Piovam; Barretto, Rodrigo Bellio de Mattos; Bihan, David Costa de Souza Le; Silva, Carlos Eduardo Suaide

doi:10.5935/2359-4802.20190017

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International Journal of Cardiovascular Sciences

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ORIGINAL ARTICLE • Int. J. Cardiovasc. Sci. 32 (05) • Sep-Oct 2019 • https://doi.org/10.5935/2359-4802.20190017 copy

Association between Morphodynamic Variables by Transesophageal Echocardiography and CHA₂DS₂-Vasc Values

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

In atrial fibrillation (AF), the CHA₂DS₂-VASc score calculates the risk for stroke. Di Biase classified the left atrial appendage (LAA), using magnetic resonance imaging, into 4 morphological types and correlated it with cerebrovascular events. Transesophageal echocardiography (TEE) also evaluates LAA and is a more widespread technique.

Objective:

To evaluate, using TEE, the possibility of characterizing LAA and to analyze its morphological aspects using the CHA₂DS₂VASc score.

Methodology:

A total of 247 patients were divided into three groups considering the CHA₂DS₂-VASc score: Group 1: 0 and 1; Group 2: 2 and 3 and, Group 3: ≥ 4 points. TEE produced the echocardiographic data. LAA was classified into thrombogenic and non-thrombogenic morphologies. In the analysis of statistical tests, a significance level of 5% was adopted.

Results:

The average age was 50 and 16.2% presented AF. In Group 1, we observed normal variables with a lower prevalence of AF (8.7%, p < 0.001). In group 2, spontaneous contrast was detected in 26.7%, (p < 0.001), thrombus in 6.7% (p = 0.079) and flow velocity in LAA < 0.4 m/s in 22.7% (p < 0.001) of the cases. Group 3 presented the highest percentages of AF (31.8%, p < 0.001), stroke/TIA (77.3%, p < 0.001), EF < 55% (18.2%, p = 0.010) and higher prevalence of thrombogenic type LAA (72.7%, p = 0.014). A higher occurrence of stroke/TIA was observed in patients with thrombogenic LAA (25.2%) compared to the non-thrombogenic group (11.2%), (p = 0.005).

Conclusions:

The thrombogenic morphology of LAA identified in TEE presented a higher risk of stroke regardless of the CHA₂DS₂VASc score. Patients with higher scores had greater abnormalities in echocardiographic variables.

Keywords:
Stroke; Atrial Fibrillation, Atrial Appendage, Arrhythmias, Cardiac; Myocardial Contraction; Echocardiography, Transesophageal

	CHA₂DS₂VASc						Total
	0 to 1		2 to 3		≥ 4		Total
	N	%	N	%	N	%	N	%
Atrial fibrillation	150		75		22		247	100.0%
Yes	13	8.7%	20	26.7%	7	31.8%	40	16.2%
No	137	91.3%	55	73.3%	15	68.2%	207	83.8%
x² (2, N = 247) = 16.28 - p < 0.001
Spontaneous contrast	150		75		22		247	100.0%
Yes	10	6.7%	20	26.7%	4	18.2%	34	13.8%
No	140	93.3%	55	73.3%	18	81.8%	213	86.2%
x² (2, N = 247) = 17.25 - p < 0.001
Left atrial dilation degree	150		75		22		247	100.0%
None	129	86.0%	44	58.7%	15	68.2%	188	76.1%
Mild	15	10.0%	17	22.7%	2	9.1%	34	13.8%
Moderate	3	2.0%	12	16.0%	5	22.7%	20	8.1%
Severe	3	2.0%	2	2.7%	0	.0%	5	2.0%
Fisher's exact test - p < 0.001
Presence of thrombus	150		75		22		247	100.0%
Yes	2	1.3%	5	6.7%	0	.0%	7	2.8%
No	148	98.7%	70	93.3%	22	100.0%	240	97.2%
Fisher's exact test - p = 0.079
Stroke/TIA	150		75		22		247	100.0%
Yes	0	.0%	29	38.7%	17	77.3%	46	18.6%
No	150	100.0%	46	61.3%	5	22.7%	201	81.4%
x² (2, N = 247) = 104.14 - p < 0.001
ICO	150		75		22		247	100.0%
Yes	3	2.0%	8	10.7%	3	13.6%	14	5.7%
No	147	98.0%	67	89.3%	19	86.4%	233	94.3%
Fisher's exact test - p = 0.004
Ejection fraction - type	150		75		22		247	100.0%
EF < 55%	6	4.0%	10	13.3%	4	18.2%	20	8.1%
EF ≥ 55%	144	96.0%	65	86.7%	18	81.8%	227	91.9%
x² (2, N = 247) = 9.15 - p = 0.010
Mean left atrial appendage velocity - type	150		75		22		247	100.0%
< 0.4 m/s	7	4.7%	17	22.7%	3	13.6%	27	10.9%
≥ 0.4 m/s	143	95.3%	58	77.3%	19	86.4%	220	89.1%
x² (2, N = 247) = 16.82 - p < 0.001
LAA group	150		75		22		247	100.0%
Thrombogenic	69	46.0%	46	61.3%	16	72.7%	131	53.0%
Non-thrombogenic	81	54.0%	29	38.7%	6	27.3%	116	47.0%
x² (2, N = 247) = 8.48 - p = 0.014

	Atrial fibrillation				Total
	Yes		No		Total
	N	%	N	%	N	%
Spontaneous contrast	40	100.0%	207	100.0%	247	100.0%
Yes	27	67.5%	7	3.4%	34	13.8%
No	13	32.5%	200	96.6%	213	86.2%
x² (1, N = 247) = 116.10 - p < 0.001
Left atrial dilation degree	40	100.0%	207	100.0%	247	100.0%
None	9	22.5%	179	86.5%	188	76.1%
Mild	14	35.0%	20	9.7%	34	13.8%
Moderate	13	32.5%	7	3.4%	20	8.1%
Severe	4	10.0%	1	.5%	5	2.0%
Fisher's exact test - p < 0.001
Presence of thrombus	40	100.0%	207	100.0%	247	100.0%
Yes	7	17.5%	0	.0%	7	2.8%
No	33	82.5%	207	100.0%	240	97.2%
Fisher's exact test - p < 0.001
Stroke/TIA	40	100.0%	207	100.0%	247	100.0%
Yes	7	17.5%	39	18.8%	46	18.6%
No	33	82.5%	168	81.2%	201	81.4%
x² (1, N = 171) = 0.04 - p = 0.842
ICO	40	100.0%	207	100.0%	247	100.0%
Yes	3	7.5%	11	5.3%	14	5.7%
No	37	92.5%	196	94.7%	233	94.3%
Fisher's exact test - p = 0.706
Ejection fraction - type	40	100.0%	207	100.0%	247	100.0%
EF < 55%	8	20.0%	12	5.8%	20	8.1%
EF ≥ 55%	32	80.0%	195	94.2%	227	91.9%
Fisher's exact test - p = 0.007
Mean left atrial appendage velocity - type	40	100.0%	207	100.0%	247	100.0%
< 0.4 m/s	24	60.0%	3	1.4%	27	10.9%
≥ 0.4 m/s	16	40.0%	204	98.6%	220	89.1%
Fisher's exact test - p < 0.001
LAA group	40	100.0%	207	100.0%	247	100.0%
Thrombogenic	23	57.5%	108	52.2%	131	53.0%
Non-thrombogenic	17	42.5%	99	47.8%	116	47.0%
x² (1, N = 247) = 0.38 - p = 0.537

	LAA groups
	Thrombogenic		Non-thrombogenic		Total
	N	%	N	%	N	%
Spontaneous contrast	131	100.0%	116	100.0%	247	100.0%
Yes	20	15.3%	14	12.1%	34	13.8%
No	111	84.7%	102	87.9%	213	86.2%
x² (1, N = 247) = 0.53 - p = 0.467
Presence of thrombus	131	100.0%	116	100.0%	247	100.0%
Yes	5	3.8%	2	1.7%	7	2.8%
No	126	96.2%	114	98.3%	240	97.2%
Fisher's exact test - p = 0.453
Stroke/TIA	131	100.0%	116	100.0%	247	100.0%
Yes	33	25.2%	13	11.2%	46	18.6%
No	98	74.8%	103	88.8%	201	81.4%
x² (1, N = 247) = 7.94 - p = 0.005

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Association between Morphodynamic Variables by Transesophageal Echocardiography and CHA2DS2-Vasc Values

Abstract

Background:

Objective:

Methodology:

Results:

Conclusions:

Association between Morphodynamic Variables by Transesophageal Echocardiography and CHA₂DS₂-Vasc Values