Am J Cardiovasc Dis 2011;1(2):159-165
Original Article
CHADS2 score is predictive of left atrial thrombus on precardioversion
transesophageal echocardiography in atrial fibrillation
Jeffrey M. Decker, Ryan D. Madder, Leaden Hickman, Victor Marinescu, Anna Marandici, Shaheena Raheem, Lynn M.
Carlyle, Richard Van Dam, Judith A. Boura, David E. Haines
Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, Michigan, USA.
Received June 27, 2011; accepted July 20, 2011; Epub July 28, 2011; published August 15, 2011
Abstract: Objective: The goals of this study were to determine: 1) if the CHADS2 score correlates with left atrial (LA) or left
atrial appendage (LAA) thrombus on pre-cardioversion transesophageal echocardiography (TEE) in nonvalvular atrial
fibrillation (NVAF); and 2) what, if any, components of the CHADS2 score are most important in predicting LA/LAA thrombus.
Background: It is unknown if CHADS2 score, a marker of thromboembolic risk in NVAF, accurately predicts LA/LAA
thrombus on pre-cardioversion TEE. Methods: We retrospectively studied patients undergoing pre-cardioversion TEE for
NVAF at a tertiary hospital. TEE reports were reviewed for presence of LA/LAA thrombus. Using medical records and an
ICD-9 coding database, a CHADS2 score was derived, and the association between CHADS2 and thrombus was
evaluated with Mantel-Haenszel Chi-Square. The relation between the singular components of CHADS2 and thrombus
were analyzed using Pearson’s Chi-Square. Results: In 643 consecutive patients undergoing pre-cardioversion TEE,
LA/LAA thrombus was identified in 46 (7.2 %). A strong association was present between CHADS2 score and LA/LAA
thrombus (p = 0.0005). No thrombi were identified in patients with CHADS2 = 0. Among 46 patients with thrombus, all
(100%) had CHF. Of the singular components, CHF was the only factor independently associated with thrombus (p <
0.0001). Conclusions: In non-valvular atrial fibrillation, CHADS2 is strongly associated with LA thrombus on TEE. Our
findings suggest pre-cardioversion TEE may be unnecessary if the CHADS2 score = 0. Of the components of the
CHADS2 score, CHF was the only independently associated risk factor which correlated with LA/LAA thrombus.
(AJCD1106005).
Keywords: Atrial fibrillation, left atrial appendage thrombus, transesophageal echocardiography, CHADS2
Full Text PDF
Address all correspondence to:
David E. Haines, M.D.
Department of Cardiovascular Medicine
Beaumont Health System
3601 W. 13 Mile Rd.
Royal Oak, MI 48073
Phone: 248-898-4198
Fax: 248-898-7239
Original Article
CHADS2 score is predictive of left atrial thrombus on precardioversion
transesophageal echocardiography in atrial fibrillation
Jeffrey M. Decker, Ryan D. Madder, Leaden Hickman, Victor Marinescu, Anna Marandici, Shaheena Raheem, Lynn M.
Carlyle, Richard Van Dam, Judith A. Boura, David E. Haines
Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, Michigan, USA.
Received June 27, 2011; accepted July 20, 2011; Epub July 28, 2011; published August 15, 2011
Abstract: Objective: The goals of this study were to determine: 1) if the CHADS2 score correlates with left atrial (LA) or left
atrial appendage (LAA) thrombus on pre-cardioversion transesophageal echocardiography (TEE) in nonvalvular atrial
fibrillation (NVAF); and 2) what, if any, components of the CHADS2 score are most important in predicting LA/LAA thrombus.
Background: It is unknown if CHADS2 score, a marker of thromboembolic risk in NVAF, accurately predicts LA/LAA
thrombus on pre-cardioversion TEE. Methods: We retrospectively studied patients undergoing pre-cardioversion TEE for
NVAF at a tertiary hospital. TEE reports were reviewed for presence of LA/LAA thrombus. Using medical records and an
ICD-9 coding database, a CHADS2 score was derived, and the association between CHADS2 and thrombus was
evaluated with Mantel-Haenszel Chi-Square. The relation between the singular components of CHADS2 and thrombus
were analyzed using Pearson’s Chi-Square. Results: In 643 consecutive patients undergoing pre-cardioversion TEE,
LA/LAA thrombus was identified in 46 (7.2 %). A strong association was present between CHADS2 score and LA/LAA
thrombus (p = 0.0005). No thrombi were identified in patients with CHADS2 = 0. Among 46 patients with thrombus, all
(100%) had CHF. Of the singular components, CHF was the only factor independently associated with thrombus (p <
0.0001). Conclusions: In non-valvular atrial fibrillation, CHADS2 is strongly associated with LA thrombus on TEE. Our
findings suggest pre-cardioversion TEE may be unnecessary if the CHADS2 score = 0. Of the components of the
CHADS2 score, CHF was the only independently associated risk factor which correlated with LA/LAA thrombus.
(AJCD1106005).
Keywords: Atrial fibrillation, left atrial appendage thrombus, transesophageal echocardiography, CHADS2
Full Text PDF
Address all correspondence to:
David E. Haines, M.D.
Department of Cardiovascular Medicine
Beaumont Health System
3601 W. 13 Mile Rd.
Royal Oak, MI 48073
Phone: 248-898-4198
Fax: 248-898-7239
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