Correlation Of Echocardiographic Test And Atrial Fibrillation Thromboembolism Risk Scoring

Purpose:Index applied in thromboembolism risk assessment system for Atrialfibrillation （AF） come from clinical indicators, and some index are subjective.Thisstudy hypothsized that echocardiography can identify the patients with atrial fibrillationat high-risk of thromboembolism. By analyzing the correlation of tntransthoracicechocardiography parameters and atrial fibrillation thromboembolism risk assessmentindicators （CHADS₂and CHA₂DS₂-VASc）, a new prediction method of risk of strokein patients with atrial fibrillation was investigated.Method:304patients who were diagnosed with atrial fibrillation in our hospitalfrom October2010to October2012,and score to each patient according to standard ofCHADS₂and CHA₂DS₂-VASc （CHADS₂: C: congestive heart failure,1point; H:hypertension,1point; A: age≥75years,1point; D: diabetes,1point; S: stroke ortransient ischemic attack history,2points,6points in all; CHA₂DS₂-VASc: C:congestive heart failure,1points; H: hypertension,1point; a: age65-74years,1point; D: diabetes,1point; S: stroke or transient cerebral ischemic attack history,2points; V: vascular disease,1point; a:age≥75years,2points, S: female,1point,9points in all）.Patients were divided into low, medium and high-risk groups accordingto the score0、1and≥2points of the cases.After admission, each patient underwenttransthoracic ultrasound echocardiography, internal diameter of right ventricle,interventricular septum thickness, left ventricular internal diameter, left ventricularposterior wall, right ventricular outflow tract width, aortic root diameter, left atrialdiameter, pulmonary artery diameter, EDT （deceleration time of E wave）, speed ofaortic valve flow and the pulmonary valve orifice flow, left ventricular ejection fraction（LVEF）. We analysis correlation of ultrasound heartbeat graph parameters andthromboembolic risk scoring by using Spearman rank.Results:（1）The low, medium and high-risk patients were76（25%）,75（25%）,153（50%） cases according to CHADS₂. The ultrasound indicators that has a significant correlation with CHADS₂score are: interventricular septal thickness （9.83±1.29mm vs10.55±2.24mm vs10.74±1.94mm, P <0.001）, left ventricular posterior wall thickness（9.59±0.95mm vs10±0.99mm vs10.09±1.18mm, P <0.001）, left atrial diameter（35.83±4.38mm vs39.12±6.21mm vs41.55±6.47mm, P <0.001）, pulmonary arterydiameter （22.53±2.62mm vs22.93±2.33mm vs23.53±2.87mm, P <0.001）, rightventricular diameter （17.37±2.11mm vs17.45±1.92mm vs17.81±2.22mm, P <0.05）,the inner diameter of the aortic root （26.92±2.75mm vs26.71±3.28mm vs26.90±2.99mm, P <0.05）, LVEF （58.09±2.05%vs57.79±3.03%vs55.77±6.50%, P <0.05）.（2）The low, medium and high-risk patients were33（10.1%）,68（22.5%）,203（66.7%）cases according to CHA₂DS₂-VASc. The ultrasound indicators that has a significantcorrelation with CHA₂DS₂-VASc score are: interventricular septal thickness （9.62±0.91mm vs10.16±1.70mm vs10.70±2.05mm, P <0.001）, left ventricular posteriorwall thickness （9.41±0.80mm vs9.88±0.99mm vs10.04±1.05mm, P <0.001）, leftatrial diameter （35.63±4.32mm vs38.03±4.54mm vs41.01±6.60mm, P <0.001）,pulmonary artery diameter （22.53±2.62mm vs22.93±2.33mm vs23.53±2.87mm, P<0.001）, aortic valve flow velocity （1.07±0.17m/s vs1.19±0.24m/s vs1.27±0.47m/s, P <0.05）, LVEF （58±2.40%vs57.82±2.74%vs56.34±5.85%, P <0.05）.Conclusion: With the CHADS₂and CHA₂DS₂-VASc score increased, cardiacultrasound showed the enlargement of left atrium, left ventricular hypertrophy,pulmonary artery diameter widened and LVEF decreased. In addition, the internaldiameter of right ventricle, aortic root diameter is associated with CHADS₂score; aorticvalve flow velocity is associated with CHA₂DS₂-VASc score. It prompted that theechocardiographic indexs such as thickness of interventricular septum, posterior wall,left atrial diameter, diameter of pulmonary artery, aortic valve flow rate and LVEF valuemay be the identification index of thromboembolism risk in non-valvular atrialfibrillation patients.