Correlation Analysis Of Transesophageal Echocardiographic Parameters And Atrial Fibrillation Thromboembolism Risk Scoring

Objective:By analyzing the correlation of atrial fibrillation (AF) thromboembolism risk assessment scoring system (CHADS2and CHA2DS2-VASc) and transesophageal echocardiography (TEE) parameters, discuss the potential medical value of TEE parameters in predicting the risk of thromboembolism in atrial fibrillation.Method:Sequentially enrolled257patients that diagnosed with atrial fibrillation in the First Affiliated Hospital of Dalian Medical University, and from March2011to September2013, than score to each patient using the standard of CHADS2and CHA2DS2-VASc scoring system. CHADS2scoring system:C:congestive heart failure,1point; H:hypertension,1point; A:age≥75years,1point; D:diabetes,1point; S:stroke or transient ischemic attack history,2points,6points in all. CHA2DS2-VASc scoring system:C:congestive heart failure,1points; H:hypertension,1point; A: age between65-74years,1point; D:diabetes,1point; S:stroke or transient ichemic attack history,2points; V:vascular disease,1point; A:age≥75years,2points; S: female,1point,9points in all. Patients were classified into high-risk, medium and low groups according to the score≥2,1and0points. After admission, using transesophageal echocardiography exam each patient. The flow of Pulmonary venous (peak S, peak D, peak A), the maximum speed of the emptying velocity of left atrial appendage (LAA), LAA entrance width, LAA depth, spontaneous echo contrast (SEC) and thrombus. We analysis the correlation of TEE parameters and thromboembolic risk scoring systems by using Spearman rank. Results:(1) High risk patients, moderate risk patients and low risk patients according to CHADS2score were84(32.7%),93(36.2%),80(31.1%). The TEE indexes that have a significant correlation with CHADS2score are:LAA entrance width (35.53±2.47mm vs35.89±0.90mm vs36.79±2.51mm, p<0.001), LAA emptying velocity (23.36±3.02cm/s vs23.03±2.00cm/s vs20.96±4.42cm/s, p<0.001), thrombus (0.00±0.000vs0.00±0.000vs0.06±0.24, p<0.001), SEC (0.00±0.000vs0.00±0.000vs0.07±0.26, p<0.001). There is s ome corre lation b etween CHADS2score and LAA width/depth (2.26±0.22vs2.30±0.12vs2.42±0.37, p=0.022).(2) The patients in high-risk group, medium±risk group and low-risk group according to CHA2DS2-VASc score were141(54.9%),69(26.8%),47(18.3%), respectively. The TEE indexes that have a significant correlation with CHA2DS2-VASc score are:LAA depth (35.37±3.17mm vs35.88±0.56mm vs36.40±2.12mm, p<0.001), LAA emptying velocity (23.75±3.15cm/s vs22.93±1.87cm/s vs21.79±3.91cm/s, p<0.001), thrombus (0.00±0.000vs0.00±0.000vs0.04±0.186, p<0.001), SEC (0.00±0.000vs0.00±0.000vs0.04±0.203, p<0.001). The TEE indexes that have some correlation with CHA2DS2±VASc score are:LAA width/depth (2.24±0.24vs2.32±0.08vs2.36±0.32, p=0.020), pulmonary venous flow A peak (25.57±4.43cm/s vs24.81±2.82cm/s vs24.29±4.51cm/s, p=0.031).Conclusion:With the CHADS2and CHA2DS2-VASc score increased, TEE parameters showed the increase of the left atrial appendage depth, the decrease of left atrial appendage emptying velocity, and increase of thrombus and spontaneous echo contrast. In addition, flow velocity of pulmonary venous peak A is correlated with CHA2DS2-VASc score. It prompted that the TEE indexes such as pulmonary venous flow, LAA emptying velocity, LAA entrance width, LAA depth, thrombus and SEC may be the identification index of thromboembolism risk in non-valvular AF patients.