title: Relationship between CHA2DS2-VASc score and atrial electromechanical function in patients with paroxysmal atrial fibrillation: A pilot study.
abstract: BACKGROUND
  CHA2DS2-VASc score is the most widely preferred method for prediction of stroke risk in patients with atrial fibrillation. We hypothesized that CHA2DS2-VASc score may represent atrial remodeling status, and therefore echocardiographic evaluation of left atrial electromechanical remodeling can be used to identify patients with high risk.
  
  
  METHODS
  A total of 65 patients who had documented diagnosis of paroxysmal atrial fibrillation (PAF) were divided into three risk groups according to the CHA2DS2-VASc score: patients with low risk (score=0, group 1), with moderate risk (score=1, group 2), and with high risk score (score ≥2, group 3). We compared groups according to atrial electromechanical intervals and left atrium mechanical functions.
  
  
  RESULTS
  Atrial electromechanical intervals including inter-atrial and intra-atrial electromechanical delay were not different between groups. However, parameters reflecting atrial mechanical functions including LA phasic volumes (Vmax, Vmin and Vp) were significantly higher in groups 2 and 3 compared with group 1. Likewise, LA passive emptying volume (LATEV) in the groups 2 and 3 was significantly higher than low-risk group (14.12±8.13ml/m(2), 22.36±8.78ml/m(2), 22.89±7.23ml/m(2), p: 0.031). Univariate analysis demonstrated that Vmax, Vmin and Vp were significantly correlated with CHA2DS2-VASc score (r=0.428, r=0.456, r=0.451 and p<0.001). Also, LATEV (r=0.397, p=0.016) and LA active emptying volume (LAAEV) (r=0.281, p=0.023) were positively correlated with CHA2DS2-VASc score. In the ROC analysis, Vmin≥11ml/m(2) has the highest predictive value for CHA2DS2-VASc score ≥2 (88% sensitivity and 89% specificity; ROC area 0.88, p<0.001, CI [0.76-0.99]).
  
  
  CONCLUSIONS
  Echocardiographic evaluation of left atrial electromechanical function might represent a useful method to identify patients with high risk.
authors.affiliation: Department of Cardiology, Sakarya University Training and Research Hospital, Sakarya, Turkey. Electronic address: bulentvatan@hotmail.com.
authors.forename: Mehmet Bülent
authors.initials: MB
authors.lastname: Vatan
authors.affiliation: Department of Cardiology, Sakarya University Training and Research Hospital, Sakarya, Turkey.
authors.forename: Sabiye
authors.initials: S
authors.lastname: Yılmaz
authors.affiliation: Department of Cardiology, Sakarya University Training and Research Hospital, Sakarya, Turkey.
authors.forename: Mustafa Tarık
authors.initials: MT
authors.lastname: Ağaç
authors.affiliation: Department of Cardiology, Sakarya University Training and Research Hospital, Sakarya, Turkey.
authors.forename: Mehmet Akif
authors.initials: MA
authors.lastname: Çakar
authors.affiliation: Department of Cardiology, Trabzon Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Erkan
authors.affiliation: Department of Cardiology, Sakarya University Training and Research Hospital, Sakarya, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Aksoy
authors.affiliation: Department of Cardiology, Sakarya University Training and Research Hospital, Sakarya, Turkey.
authors.forename: Saadet
authors.initials: S
authors.lastname: Demirtas
authors.affiliation: Department of Internal Medicine, Sakarya University Training and Research Hospital, Sakarya, Turkey.
authors.forename: Ceyhun
authors.initials: C
authors.lastname: Varım
authors.affiliation: Department of Cardiology, Sakarya University Training and Research Hospital, Sakarya, Turkey.
authors.forename: Ramazan
authors.initials: R
authors.lastname: Akdemir
authors.affiliation: Department of Cardiology, Sakarya University Training and Research Hospital, Sakarya, Turkey.
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Gündüz
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000503:physiopathology*; D016279:Atrial Function, Left / Q000502:physiology*; D064752:Atrial Remodeling; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology*
keywords: Atrial fibrillation; Echocardiography; Remodeling; Risk stratification