title: Severe Spontaneous Echo Contrast/Auricolar Thrombosis in "Nonvalvular" AF: Value of Thromboembolic Risk Scores.
abstract: BACKGROUND
  Patients with atrial fibrillation (AF) have an increased thromboembolic risk that can be estimated with risk scores and sometimes require oral anticoagulation therapy (OAT). Despite correct anticoagulation, some patients still develop left atrial spontaneous echo contrast (SEC) or thrombosis. The value of traditional risk scores (R2CHADS2, CHADS2, and CHA2DS2-VASc) in predicting such events remains controversial.
  
  
  RESULTS
  The aim of our study was to explore variables linked to severe SEC or atrial thrombosis and evaluate the performance of traditional risk scores in identifying these patients. In order to do this, we retrospectively analyzed 568 patients with nonvalvular nonparoxysmal AF who underwent electrical cardioversion from January 2011 to December 2016 after OAT for a minimum of 4 weeks. A transesophageal echocardiogram was performed in 265 patients for various indications, and 24 exhibited left atrial SEC or thrombosis. Female gender, history of heart failure or left ventricular ejection fraction <40%, and high levels (>1 mg/dL) of C-reactive protein (CRP) were independently associated with left atrial SEC/thrombosis. A score composed by these factors (denominated HIS [Heart Failure, Inflammation, and female Sex]) showed a sensitivity of 79% and a specificity of 60% (area under receiver operating characteristic curve 0.695, P = 0.002) in identifying patients with a positive transesophageal echo; traditional risk scores did not perform as well.
  
  
  CONCLUSIONS
  In patients with persistent AF and suboptimal anticoagulation, a risk score composed by history of heart failure, high CRP, and female gender identifies patients at high risk of left atrial SEC/thrombosis when its value is >1.
authors.affiliation: Cardiovascular Department, Cliniche Humanitas Gavazzeni, Bergamo, Italy.
authors.forename: Giosuè
authors.initials: G
authors.lastname: Mascioli
authors.affiliation: Cardiovascular Department, Cliniche Humanitas Gavazzeni, Bergamo, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Lucca
authors.affiliation: Cardiovascular Department, Cliniche Humanitas Gavazzeni, Bergamo, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Michelotti
authors.affiliation: Cardiovascular Department, Cliniche Humanitas Gavazzeni, Bergamo, Italy.
authors.forename: Giusy
authors.initials: G
authors.lastname: Alioto
authors.affiliation: Cardiovascular Department, Cliniche Humanitas Gavazzeni, Bergamo, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Santoro
authors.affiliation: Cardiovascular Department, Cliniche Humanitas Gavazzeni, Bergamo, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Belli
authors.affiliation: Cardiovascular Department, Cliniche Humanitas Gavazzeni, Bergamo, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Rota
authors.affiliation: Cardiovascular Department, Cliniche Humanitas Gavazzeni, Bergamo, Italy.
authors.forename: Ombretta
authors.initials: O
authors.lastname: Ornago
authors.affiliation: Cardiovascular Department, Cliniche Humanitas Gavazzeni, Bergamo, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Sirianni
authors.affiliation: Cardiovascular Department, Cliniche Humanitas Gavazzeni, Bergamo, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Pulcini
authors.affiliation: Cardiovascular Department, Cliniche Humanitas Gavazzeni, Bergamo, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Pennesi
authors.affiliation: Cardiovascular Department, Cliniche Humanitas Gavazzeni, Bergamo, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Savasta
authors.affiliation: Cardiovascular Department, Cliniche Humanitas Gavazzeni, Bergamo, Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Russo
authors.affiliation: Cardiovascular Department, Cliniche Humanitas Gavazzeni, Bergamo, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Pitì
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D003287:Contrast Media; D017548:Echocardiography, Transesophageal / Q000706:statistics & numerical data*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology*; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017678:Sex Distribution; D013318:Stroke Volume; D013927:Thrombosis / Q000175:diagnosis* / Q000453:epidemiology*
chemical_list: D003287:Contrast Media
keywords: atrial fibrillation; echocardiography; risk factor; thrombosis