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

BackgroundThe CHA(2)DS(2)-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 CHA(2)DS(2)-VASc score in the development of thrombogenesis and their potential correlation with LAA-FV and LA strain. Hypothesis AF rhythm and high CHA(2)DS(2)-VASc score correlate independently with decreased LAA-FV, which can be predicted by LA strain. MethodsIn 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 CHA(2)DS(2)-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 CHA(2)DS(2)-VASc score (coefficient = -0.317, P = 0.013), and the CHA(2)DS(2)-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. ConclusionsAF rhythm caused a sharp decrease in LAA-FV independent of CHA(2)DS(2)-VASc score. In SR, the CHA(2)DS(2)-VASc score correlated negatively with LAA-FV. LA strain was a predictor of LAA-FV in both SR and AF rhythm.