Relationship between CHA2DS2-VASc score and atrial electromechanical function in patients with paroxysmal atrial fibrillation: A pilot study

A B S T R A C T 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 8.13 ml/m 2 , 22.36 8.78 ml/m 2 , 22.89 7.23 ml/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 11 ml/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]). Conclusion: Echocardiographic evaluation of left atrial electromechanical function might represent a useful method to identify patients with high risk.