Additional value of left atrial appendage geometry and hemodynamics when considering anticoagulation strategy in patients with atrial fibrillation with low CHA2DS2-VASc scores

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

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background Strokes occur in some patients with atrial fibrillation (AF), even when the CHA2DS2-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 CHA2DS2-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 CHA2DS2-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 cm2 vs 2.83 ± 0.9 cm2; 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 cm2) were independent predictors of stroke. Patients with an LAA flow velocity of <40 cm/s and an LAA orifice of >4.0 cm2 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 CHA2DS2-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.

Original languageEnglish
Pages (from-to)1297-1301
Number of pages5
JournalHeart Rhythm
Volume14
Issue number9
DOIs
Publication statusPublished - 2017 Sep

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Atrial Appendage
Atrial Fibrillation
Hemodynamics
Stroke
Odds Ratio
Transient Ischemic Attack
Vascular Diseases
Anticoagulants
Diabetes Mellitus
Heart Failure
Prospective Studies
Confidence Intervals
Hypertension
Control Groups

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

@article{693b4f0ceb7247d59246c425764a0e82,
title = "Additional value of left atrial appendage geometry and hemodynamics when considering anticoagulation strategy in patients with atrial fibrillation with low CHA2DS2-VASc scores",
abstract = "Background Strokes occur in some patients with atrial fibrillation (AF), even when the CHA2DS2-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 CHA2DS2-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 CHA2DS2-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 cm2 vs 2.83 ± 0.9 cm2; 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 cm2) were independent predictors of stroke. Patients with an LAA flow velocity of <40 cm/s and an LAA orifice of >4.0 cm2 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 CHA2DS2-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.",
author = "Lee, {Jung Myung} and Kim, {Jin Bae} and Uhm, {Jae Sun} and Pak, {Hui Nam} and Lee, {Moon Hyoung} and Boyoung Joung",
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Additional value of left atrial appendage geometry and hemodynamics when considering anticoagulation strategy in patients with atrial fibrillation with low CHA2DS2-VASc scores. / Lee, Jung Myung; Kim, Jin Bae; Uhm, Jae Sun; Pak, Hui Nam; Lee, Moon Hyoung; Joung, Boyoung.

In: Heart Rhythm, Vol. 14, No. 9, 09.2017, p. 1297-1301.

Research output: Contribution to journalArticle

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T1 - Additional value of left atrial appendage geometry and hemodynamics when considering anticoagulation strategy in patients with atrial fibrillation with low CHA2DS2-VASc scores

AU - Lee, Jung Myung

AU - Kim, Jin Bae

AU - Uhm, Jae Sun

AU - Pak, Hui Nam

AU - Lee, Moon Hyoung

AU - Joung, Boyoung

PY - 2017/9

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N2 - Background Strokes occur in some patients with atrial fibrillation (AF), even when the CHA2DS2-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 CHA2DS2-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 CHA2DS2-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 cm2 vs 2.83 ± 0.9 cm2; 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 cm2) were independent predictors of stroke. Patients with an LAA flow velocity of <40 cm/s and an LAA orifice of >4.0 cm2 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 CHA2DS2-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.

AB - Background Strokes occur in some patients with atrial fibrillation (AF), even when the CHA2DS2-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 CHA2DS2-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 CHA2DS2-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 cm2 vs 2.83 ± 0.9 cm2; 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 cm2) were independent predictors of stroke. Patients with an LAA flow velocity of <40 cm/s and an LAA orifice of >4.0 cm2 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 CHA2DS2-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.

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