Abstract
BACKGROUND: Elevated CHA(2)DS(2)-VASc scores are considered to be predictors of left atrial appendage (LAA) thrombus (LAAT); however, individuals with low scores remain at risk. Studies have indicated that aortic atherosclerosis (AA) is associated with increased stroke risk. AA on transoesophageal echocardiography (TOE) has been overlooked as a 'vascular' variable in the CHA(2)DS(2)-VASc score. AIMS: Determine the prevalence of LAAT in patients with low thromboembolic risk and the correlation of AA with LAAT. METHODS: We performed a retrospective review of all TOEs performed for patients who underwent electrophysiology procedures at the McGill University Health Centre from 2012 to 2017 and collected pertinent clinical and echocardiography variables. We reviewed all TOEs to evaluate the presence and severity of AA using the Katz score, American Society of Echocardiography (ASE) grade and the Ferrari score. In patients with a CHADS(2) of 0 and CHA(2)DS(2)-VASc score of ≤1, logistical regression and receiver operating characteristic curves were used to identify predictors for LAAT. RESULTS: 592 patients underwent a pre-procedure TOE and were included in the analysis. Among 249 patients with CHA(2)DS(2)-VASc scores ≤1, 7.5% had LAA. AA burden by Katz score was an independent predictor of LAAT (area under the curve (AUC) 0.76 95% CI [0.60-0.92]) for CHA(2)DS(2)-VASc ≤1. CONCLUSION: AA visualised on TOE was significantly associated with an increased risk of LAAT development in patients with low CHA(2)DS(2)-VASc scores. Incorporating AA assessment into risk stratification may enhance clinical decision-making for the use of anticoagulation for patients with AF. Future studies are warranted to evaluate the use of other imaging modalities for AA detection.