title: CHADS(2) and CHA(2)DS          (2)-VASc score of patients with atrial fibrillation or flutter and newly detected left atrial thrombus.
abstract: BACKGROUND
  The risk of developing a stroke or systemic embolus due to a left atrial (LA) thrombus in patients with atrial fibrillation (AF) and/or atrial flutter (AFL) is estimated by the CHADS(2) score and more recently the CHA(2)DS(2)-VASc score. We aimed to further characterize AF/AFL patients who were found to have a LA thrombus on a transesophageal echocardiogram (TEE).
  
  
  RESULTS
  Of 3,165 TEE between 2005 and 2011 for a broad spectrum of indications, we detected 65 AF patients with LA thrombus (2 %). There were 40 men and 25 women, mean age was 65 ± 13 years (range 36-88 years). Mean CHADS(2) score was 1.8 ± 1.1 and mean CHA(2)DS(2)-VASc score was 3.0 ± 1.6. 11 patients (17 %) had a CHADS(2) score of 0, 12 patients (18 %) of 1, 28 patients (43 %) of 2 and 12 patients (18 %) of 3. Hypertension was the most frequent risk factor (72 %), followed by congestive heart failure (32 %), diabetes (23 %) and age ≥75 years (23 %). Mean difference between CHADS(2) and CHA(2)DS(2)-VASc was 1.25 ± 0.91. Of the 11 patients (17 %) with a LA thrombus despite a CHADS(2) score of 0, five had a CHA(2)DS(2)-VASc score of 0, four a CHA(2)DS(2)-VASc score of 1 and two a CHA(2)DS(2)-VASc score of 2.
  
  
  CONCLUSIONS
  In an unselected TEE population with newly detected LA thrombus about one-third of patients fell into the low-risk group when classified based on the CHADS(2) score, while a much lower population fell in the same low-risk group when classified according to the CHA(2)DS(2)-VASc score. However, this does not prove clinical superiority of the CHA(2)DS(2)-VASc score over the established CHADS(2) score. Whether our observation has clinical implications (e.g. TEE prior to LA ablation irrespective of CHADS(2) score), or argues for use of the CHA(2)DS(2)-VASc score needs to be evaluated in prospective studies.
authors.affiliation: Division of Electrophysiology, Department of Cardiovascular Medicine, Hospital of the Westfälische Wilhelms-University, Münster, Germany, wasmerk@ukmuenster.de.
authors.forename: Kristina
authors.initials: K
authors.lastname: Wasmer
authors.forename: Julia
authors.initials: J
authors.lastname: Köbe
authors.forename: Dirk
authors.initials: D
authors.lastname: Dechering
authors.forename: Peter
authors.initials: P
authors.lastname: Milberg
authors.forename: Christian
authors.initials: C
authors.lastname: Pott
authors.forename: Julia
authors.initials: J
authors.lastname: Vogler
authors.forename: Jörg
authors.initials: J
authors.lastname: Stypmann
authors.forename: Johannes
authors.initials: J
authors.lastname: Waltenberger
authors.forename: Gerold
authors.initials: G
authors.lastname: Mönnig
authors.forename: Günter
authors.initials: G
authors.lastname: Breithardt
authors.forename: Lars
authors.initials: L
authors.lastname: Eckardt
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications* / Q000175:diagnosis; D001282:Atrial Flutter / Q000150:complications* / Q000175:diagnosis; D003661:Decision Support Techniques; D048909:Diabetes Complications / Q000209:etiology; D017548:Echocardiography, Transesophageal; D004617:Embolism / Q000209:etiology*; D005260:Female; D006333:Heart Failure / Q000150:complications; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology*; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology*