Comparison of different thromboembolism risk scores with the predictive value of left atrial thrombosis and/or spontaneous ultrasound in patients with non valvular atrial fibrillation

Objective: To compare the predictive value of CHADS2, CHA2DS2-VASc, ATRIA and R2-CHADS2 scores and left atrial thrombosis and/or spontaneous ultrasound in patients with non valvular atrial fibrillation (AF) Methods patients with non valvular atrial fibrillation who were hospitalized in the Department of Cardiology of Sun Yat Sen Memorial Hospital of Sun Yat sen University from January 2007 to July 2019 and underwent transesophageal echocardiography were included. The clinical data and relevant auxiliary examination results were collected, and CHADS2, CHA2DS2-VASc, ATRIA and R2-CHADS2 scores were performed respectively. The incidence of left atrial thrombosis and/or spontaneous ultrasound development under different scores and thromboembolism risk stratification were calculated, Four scores were compared to predict the area under the ROC curve of left atrial thrombosis and/or spontaneous ultrasound in patients with non valvular atrial fibrillation Results 564 patients were included. The age of patients was (61.1 ± 10.1) years old, of which 63.3% were men. Hypertension was the most common complication, which was found in 49.6% of patients Patients were divided into thrombus group (n = 82) and non thrombus group (n = 482) according to the presence of left atrial thrombus and/or spontaneous ultrasound development CHADS2 score in thrombotic group (1[0,2]) was higher than that in non thrombotic group (1[0,1]) (P < 0.05), and CHA2DS2-VASc score in thrombotic group (2[1,3]) was higher than that in non thrombotic group (2[1,2]) (P < 0.05) 11.06%, 13.39%, 26.58%, 18.52% and 16.67% of patients with CHADS2 score of 0, 1, 2, 3 and 4 had left atrial thrombus and/or spontaneous ultrasound (P fortrend = 0.016), and 11.06%, 13.39% and 23.68% of patients with low, medium and high risk had left atrial thrombus and/or spontaneous ultrasound (P fortrend = 0.004); 10.81%, 10.19%, 16.57%, 21.05%, 21.05%, 16.67%, 14.29% of patients with CHA2DS2-VASc score of 0, 1, 2, 3, 4, 5, 6 or above had left atrial thrombosis and/or spontaneous ultrasound development (P fortrend = 0.019), and 8.75%, 13.90% and 19.35% of patients with low, medium and high risk had left atrial thrombosis and/or spontaneous ultrasound development (P fortrend = 0.004); With the increase of scores or risk stratification, the incidence of left atrial thrombosis and/or spontaneous ultrasound development also increased gradually (P < 0.05). Atria score and R2-CHADS2 score were not statistically significant in the comparison of the two groups, and there was no such change trend (P>0.05) The area under the ROC curve of CHADS2 score and CHA2DS2-VASc score was 0.586 (P < 0.05). There was no significant difference in the predictive value of the two scoring methods for left atrial thrombosis and/or spontaneous ultrasound development The area under the ROC curve of ATRIA score and R2-CHADS2 score was 0.562. The samples based on this study had no statistical significance in the diagnosis of left atrial thrombosis and/or spontaneous ultrasound (P>0.05) Conclusion CHADS2 score and CHA2DS2-VASc score have considerable and limited diagnostic value for left atrial thrombosis and/or spontaneous ultrasound in patients with non valvular atrial fibrillation. Atria score and R2-CHADS2 score do not reflect predictive value in the study based on this sampl