title: Association of the CHA2DS2-VASc score with left atrial spontaneous echo contrast: a cross-sectional study of patients with rheumatic mitral stenosis in sinus rhythm.
abstract: Mitral valve stenosis is a common manifestation of chronic rheumatic heart disease. In rheumatic mitral valve stenosis (RMVS) patients, left atrial spontaneous echo contrast (LASEC) is an independent predictor of thromboembolism risk. While the anticoagulant therapy algorithm for atrial fibrillation patients is clear, the clinical tools determining high-risk patients in sinus rhythm are insufficient. Our aim is to examine the relationship between CHA2DS2-VASc score in RMVS patients in sinus rhythm and the presence of LASEC. The patients with RMVS upon presentation to the cardiology polyclinic were included in this cross-sectional study consecutively, and CHA2DS2-VASc scores were calculated. All patients were evaluated with transthoracic and transesophageal echocardiography and were divided into two groups as those with and without LASEC. The total number of patients was 265, with LASEC determined in 97 (36.6 %) and not determined in 168 (63.4 %). No significant differences in terms of age, gender, and body mass index were found between the groups. Patients with LASEC had higher mean CHA2DS2-VASc score than patients without LASEC (2.10 ± 1.21 vs. 1.11 ± 0.7, respectively; p < 0.001). In the multivariate logistic regression analysis, it has been determined that there is an independent association between the existence of LASEC and CHA2DS2-VASc score (OR 3.176, CI 1.937-5.206; p < 0.001). The ROC analysis revealed that CHA2DS2-VASc score 2 or more predicted presence of LASEC with a sensitivity of 71 % and a specificity of 82 % (AUC 0.746, 95 % CI 0.682-0.810). The CHA2DS2-VASc score could be useful marker to detect prothrombotic state in patients with RMVS in sinus rhythm.
authors.affiliation: Department of Cardiology, Okmeydanı Training and Research Hospital, Darülaceze Street. No: 25 Okmeydanı, Sisli, 34384, Istanbul, Turkey. belenerdal@gmail.com.
authors.forename: Erdal
authors.initials: E
authors.lastname: Belen
authors.affiliation: Department of Cardiology, Pendik State Hospital, Istanbul, Turkey.
authors.forename: Ender
authors.initials: E
authors.lastname: Ozal
authors.affiliation: Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
authors.forename: Hamdi
authors.initials: H
authors.lastname: Pusuroglu
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D016279:Atrial Function, Left; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D015150:Echocardiography, Doppler; D017548:Echocardiography, Transesophageal; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006339:Heart Rate; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012372:ROC Curve; D012214:Rheumatic Heart Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology*; D013923:Thromboembolism / Q000175:diagnosis / Q000209:etiology*
keywords: CHA2DS2-VASc; Left atrial spontaneous echo contrast; Rheumatic mitral valve stenosis