title: Correlation between cardiac rhythm, left atrial appendage flow velocity, and CHA2DS2-VASc score: Study based on transesophageal echocardiography and 2-dimensional speckle tracking.
abstract: BACKGROUND
  The CHA2DS2-VASc score is a classic predictor of stroke in patients with atrial fibrillation (AF). Decreased left atrial appendage flow velocity (LAA-FV) reflects the blood stasis, and left atrial (LA) strain is a manifestation of atrial remodeling. This study aimed to explore the effects of AF rhythm and CHA2DS2-VASc score in the development of thrombogenesis and their potential correlation with LAA-FV and LA strain.
  
  
  OBJECTIVE
  AF rhythm and high CHA2DS2-VASc score correlate independently with decreased LAA-FV, which can be predicted by LA strain.
  
  
  METHODS
  In 98 AF patients, LAA-FV was measured by transesophageal echocardiography and LA strain was measured by transthoracic echocardiography.
  
  
  RESULTS
  LAA-FV decreased sharply in the AF rhythm group (26.22 vs 61.87 mm/s; P < 0.001), and CHA2DS2-VASc score did not differ between the decreased and normal LAA-FV groups in all patients (P = 0.289). However, in sinus rhythm (SR), LAA-FV was associated with CHA2DS2-VASc score (coefficient = -0.317, P = 0.013), and the CHA2DS2-VASc score differed between the normal and decreased LAA-FV groups (2 [0-7] vs 3 [0-6], respectively; P = 0.038). Moreover, LA strain was a predictor of LAA-FV in both AF rhythm and SR, whereas a peak positive systolic strain divided by LA volume index <0.744 predicted decreased LAA-FV.
  
  
  CONCLUSIONS
  AF rhythm caused a sharp decrease in LAA-FV independent of CHA2DS2-VASc score. In SR, the CHA2DS2-VASc score correlated negatively with LAA-FV. LA strain was a predictor of LAA-FV in both SR and AF rhythm.
authors.affiliation: Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Kun
authors.initials: K
authors.lastname: Zuo
authors.affiliation: Department of Echocardiography, Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Lanlan
authors.initials: L
authors.lastname: Sun
authors.affiliation: Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Xinchun
authors.initials: X
authors.lastname: Yang
authors.affiliation: Department of Echocardiography, Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Xiuzhang
authors.initials: X
authors.lastname: Lyu
authors.affiliation: Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Kuibao
authors.initials: K
authors.lastname: Li
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D064752:Atrial Remodeling / Q000502:physiology*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology; D013997:Time Factors
keywords: CHA2DS2-VASc score; atrial fibrillation; cardiac rhythm; left atrial appendage flow velocity; strain; stroke; transesophageal echocardiography; two-dimensional speckle tracking