Relationship between CHA2DS2-VASc Score and Left Ventricular Apical Thrombosis in Patients with Heart Failure

Abstract

Objective: Left ventricular apical thrombus (LVAT) is associated with increased morbidity and mortality in patients after acute myocardial infarction. In this study, it was aimed to evaluate the relationship between the left ventricle apical thrombosis and the CHA2DS2-VASc scoring system.

Materials and Methods: A total of 456 patients (146 with LVAT, 300 without ventricular thrombosis with demographic characteristics similar to the control group) followed in our clinic between January 2010 and January 2020 were included in this study.

Results: The mean CHA2DS2-VASc score was calculated as 3.05±1.34 in the whole study population during diagnosis and CHA2DS2-VASc score was higher statistical significance in the LVAT (p= 0.029). While the number of patients with CHA2DS2-VASc score above 2 in the LVAT group was 79%, it was 55% in the control group (p <0.001). The ejection fraction was similar between the groups (p= 0.793) but left ventricular diastolic/systolic diameters and the left atrium diameter were larger in patients with the LVAT group (p= 0.793, p= 0.001, respectively). The CHA2DS2-VASc score, and presence of coronary artery disease were independent risk factors for LVAT (β= 0.385, p= 0.001, β= 0.265, p= 0.045, respectively).

Conclusion: According to the data in our study, the CHA2DS2-VASc score tended to be higher in patients with LVAT and a higher CHA2DS2-VASc score was found to be an independent predictor of incidence of LVAT. Left ventricular thrombus should be kept in mind in heart failure patients with a history of idiopathic systemic embolism and high CHA2DS2-VASc score (≥2). 

Keywords

• Left ventriküler apikal trombüs
• CHA2DS2-VASc score
• heart failure

Kalp Yetmezlikli Hastalarda CHA2DS2-VASc Skoru ve Sol Ventrikül Apikal Trombozu İlişkisi

Öz

Amaç: Sol ventrikül apikal trombüsü (LVAT), akut miyokard enfarktüsü sonrası hastalarda artmış morbidite ve mortalite ile ilişkilidir. Bu çalışmada sol ventrikül apikal trombozu ile CHA2DS2-VASc skorlama sistemi arasındaki ilişkiyi değerlendirmek amaçlandı.

Materyal ve Metot: Bu çalışmaya Ocak 2010 ile Ocak 2020 arasında kliniğimizde takip edilen 456 (LVAT'li 146, kontrol grubu ile benzer demografik özelliklere sahip ventriküler trombozu olmayan 300) hasta dahil edildi.

Bulgular: Tüm çalışma popülasyonunda tanı sırasında ortalama CHA2DS2-VASc skoru 3,05±1,34 olarak hesaplandı ve CHA2DS2-VASc skoru LVAT'de istatistiksel olarak daha yüksekti (p= 0,029). LVAT grubunda CHA2DS2-VASc skoru 2'nin üzerinde olan hasta sayısı %79 iken kontrol grubunda %55 idi (p <0,001). Ejeksiyon fraksiyonu gruplar arasında benzerdi, ancak LVAT grubundaki hastalarda sol ventrikül diyastolik/sistolik çapları ve sol atriyum çapı daha büyüktü (sırasıyla; p=0,793, p=0,001). CHA2DS2-VASc skoru, koroner arter hastalığı varlığı LVAT için bağımsız risk faktörleriydi (sırasıyla; β= 0,385, p= 0,001, β= 0,265, p= 0,045).

Sonuç: LVAT'li hastalarda CHA2DS2-VASc skoru daha yüksek olma eğilimindeydi ve daha yüksek bir CHA2DS2-VASc skoru, LVAT insidansının bağımsız bir öngördürücüsü olarak bulundu. İdiyopatik sistemik emboli öyküsü olan ve yüksek CHA2DS2-VASc skoru (≥2) olan kalp yetmezliği hastalarında sol ventrikül trombüsü akılda tutulmalıdır. 

Anahtar Kelimeler

• Sol ventriküler apikal trombüs
• CHA2DS2-VASc skoru
• kalp yetmezliği

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