segunda-feira, maio 03, 2010
Contraste espontâneo como preditor de trombos
Predicting left atrial thrombi in atrial fibrillation.
American Heart Journal. 159(4):665-671, April 2010.
AB Background: The aim of the study was to determine whether CHADS2 score is predictive of left atrial appendage thrombus (LAAT) in nonvalvular atrial fibrillation (AF).
Methods: Nonanticoagulated, nonvalvular AF patients with (cases) or without (controls) LAAT by transesophageal echocardiography were identified using Mayo Clinic Echocardiography and Cardioversion Unit Databases (Rochester, MN). Type and duration of AF, CHADS2 score, and echocardiography measures were compared to determine variables predictive of LAAT. Results: The CHADS2 score was significantly higher for cases (n = 110, mean +/- SD 2.8 +/- 1.6) compared to controls (n = 387, 1.6 +/- 1.3). By multivariate analysis, independent predictors of LAAT included heart failure (HR 5.78, P < 0001), prior stroke/transient ischemic attack (HR 3.94, P < .0001), diabetes mellitus (HR 1.98, P = .015), permanent AF (HR 3.02, P < .05), AF duration (HR 2.24, P < .05), and spontaneous echocardiographic contrast (HR 4.35, P = .005). Using these elements, a new scoring system provided cleaner case-control separation (C-index 0.90) and higher predictive power compared to CHADS2 (C-index 0.71).
Conclusions: By including only echo and clinical variables predictive of LAAT, our novel scoring system better identified those AF patients at greatest cardioembolic risk.