Correlation between cardiac rhythm, left atrial appendage flow velocity, and CHA2DS2-VASc score: Study based on transesophageal echocardiography and 2-dimensional speckle tracking

Abstract

Background: The CHA2DS2-VASc score is a classic predictor of stroke in patients with atrial fibrillation (AF). Decreased left atrial appendage flow velocity (LAA-FV) reflects the blood stasis, and left atrial (LA) strain is a manifestation of atrial remodeling. This study aimed to explore the effects of AF rhythm and CHA2DS2-VASc score in the development of thrombogenesis and their potential correlation with LAA-FV and LA strain. Hypothesis: AF rhythm and high CHA2DS2-VASc score correlate independently with decreased LAA-FV, which can be predicted by LA strain. Methods: In 98 AF patients, LAA-FV was measured by transesophageal echocardiography and LA strain was measured by transthoracic echocardiography. Results: LAA-FV decreased sharply in the AF rhythm group (26.22 vs 61.87 mm/s; P < 0.001), and CHA2DS2-VASc score did not differ between the decreased and normal LAA-FV groups in all patients (P = 0.289). However, in sinus rhythm (SR), LAA-FV was associated with CHA2DS2-VASc score (coefficient = −0.317, P = 0.013), and the CHA2DS2-VASc score differed between the normal and decreased LAA-FV groups (2 [0–7] vs 3 [0–6], respectively; P = 0.038). Moreover, LA strain was a predictor of LAA-FV in both AF rhythm and SR, whereas a peak positive systolic strain divided by LA volume index <0.744 predicted decreased LAA-FV. Conclusions: AF rhythm caused a sharp decrease in LAA-FV independent of CHA2DS2-VASc score. In SR, the CHA2DS2-VASc score correlated negatively with LAA-FV. LA strain was a predictor of LAA-FV in both SR and AF rhythm.