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

Kaynakça

1. Choi UL, Park JH, Sun BJ, Oh JK, Seong SW, Lee JH. Impaired left ventricular diastolic function is related to the formation of left ventricular apical thrombus in patients with acute anterior myocardial infarction. Heart Vessels. 2018;33(5):447-452. doi:10.1007/s00380-017-1079-z
2. Satish M, Vukka N, Apala D, Mahfood Haddad T, Gupta J. Left ventricular thrombus after acute decompensated heart failure in the setting of ıschemic cardiomyopathy. Cureus. 2019;11(4):e4537. doi:10.7759/cureus.4537
3. Lemaître AI, Picard F, Maurin V, Faure M, Dos Santos P, Girerd N. Clinical profile and midterm prognosis of left ventricular thrombus in heart failure. ESC Heart Fail. 2021. doi:10.1002/ehf2.13211
4. Lee JM, Park JJ, Jung HW, et al. Left ventricular thrombus and subsequent thromboembolism, comparison of anticoagulation, surgical removal, and antiplatelet agents. J Atheroscler Thromb. 2013;20(1):73-93. doi:10.5551/jat.13540
5. McCarthy CP, Vaduganathan M, McCarthy KJ, Januzzi JL Jr, Bhatt DL, McEvoy JW. Left ventricular thrombus after acute myocardial ınfarction: screening, prevention, and treatment. JAMA Cardiol. 2018;3(7):642-649. doi:10.1001/jamacardio.2018.1086
6. Aljaber NN, Mattash ZA, Alshoabi SA, Alhazmi FH. The prevalence of left ventricular thrombus among patients with low ejection fraction by trans-thoracic echocardiography. Pak J Med Sci. 2020;36(4):673-677. doi:10.12669/pjms.36.4.1972
7. Kirchhof P, Benussi S, Kotecha D, ve ark. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace. 2016;18(11):1609-1678.
8. Akboğa MK, Yılmaz S, Yalçın R. Prognostic value of CHA2DS2-VASc score in predicting high SYNTAX score and in-hospital mortality for non-ST elevation myocardial infarction in patients without atrial fibrillation. Anatol J Cardiol. 2021;25(11):789-795. doi:10.5152/AnatolJCardiol.2021.03982

9. Temizer O, Açar B, Yayla Ç, ve ark. The association between CHA2DS2-VASc score and mortality in patients with heart failure with reduced ejection fraction. Acta Cardiol Sin. 2017;33(4):429-435.
10. Onuk T, Karataş MB, İpek G, ve ark. Higher CHA2DS2-VASc score is associated with increased mortality in acute pulmonary embolism. Clin Appl Thromb Hemost. 2017;23(6):631-637.
11. Ünal S, Açar B, Yayla Ç, ve ark. Importance and usage of the CHA2DS2-VASc score in predicting acute stent thrombosis. Coron Artery Dis. 2016;27(6):478-82. doi:10.1097/MCA.0000000000000388
12. Camm AJ, Kirchhof P, Lip GY, ve ark. Guidelines for the management of atrial fibrillation: The task force for the management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) endorsed by the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2010;31(19):2369-429. doi:10.1093/eurheartj/ehq278
13. Yu I, Song TJ, Kim BJ, et al. CHADS2, CHA2DS2-VASc, ATRIA, and Essen stroke risk scores in stroke with atrial fibrillation: A nationwide multicenter registry study. Medicine (Baltimore). 2021;100(3):e24000. doi:10.1097/MD.0000000000024000
14. Mir JU, Raheel Jahangir J, Asfandyar Q, Sher Ali K, Syed Abbas A, Muhammad Zeeshan H. Left ventricular thrombus in patients with acute anterior wall myocardial infarction. J Ayub Med Coll Abbottabad. 2014;26(4):491-495.
15. Gellen B, Biere L, Logeart D, ve ark. Timing of cardiac magnetic resonance imaging impacts on the detection rate of left ventricular thrombus after myocardial ınfarction. JACC Cardiovasc Imaging. 2017;10(11):1404-1405. doi:10.1016/j.jcmg.2016.12.006
16. Bakalli A, Georgievska-Ismail L, Koçinaj D, Musliu N, Krasniqi A, Pllana E. Prevalence of left chamber cardiac thrombi in patients with dilated left ventricle at sinus rhythm: the role of transesophageal echocardiography. J Clin Ultrasound. 2013;41(1):38-45. doi:10.1002/jcu.21953
17. Hopper I, Skiba M, Krum H. Updated meta-analysis on antithrombotic therapy in patients with heart failure and sinus rhythm. Eur J Heart Fail. 2013;15(1):69-78. doi:10.1093/eurjhf/hfs171
18. Velangi PS, Choo C, Chen KA, ve ark. Long-term embolic outcomes after detection of left ventricular thrombus by late gadolinium enhancement cardiovascular magnetic resonance imaging: A matched cohort study. Circ Cardiovasc Imaging. 2019;12(11):e009723. doi:10.1161/CIRCIMAGING.119.009723
19. You J, Wang X, Wu J, ve ark. Predictors and prognosis of left ventricular thrombus in post-myocardial infarction patients with left ventricular dysfunction after percutaneous coronary intervention. J Thorac Dis. 2018;10(8):4912-4922. doi:10.21037/jtd.2018.07.69
20. Zannad F, Stough WG, Regnault V, ve ark. Is thrombosis a contributor to heart failure pathophysiology? Possible mechanisms, therapeutic opportunities, and clinical investigation challenges. Int J Cardiol. 2013;167(5):1772-82. doi:10.1016/j.ijcard.2012.12.018
21. Jiwani S, Mustafa U, Desai S, Dominic P. Survival benefit of aspirin in patients with congestive heart failure: A meta-analysis. J Clin Med Res. 2021;13(1):38-47. doi:10.14740/jocmr4389
22. Iguchi M, Kato T, Yaku H, ve ark. Ischemic stroke in acute decompensated heart failure: From the KCHF registry. J Am Heart Assoc. 2021;10(21):e022525. doi:10.1161/JAHA.121.022525
23. Zhang S, Wang T, Wang H, ve ark. Effects of individualized administration of folic acid on prothrombotic state and vascular endothelial function with H-type hypertension: A double-blinded, randomized clinical cohort study. Medicine (Baltimore). 2022;101(3):e28628. doi:10.1097/MD.0000000000028628
24. Cullivan S, Murphy CA, Weiss L, ve ark. Platelets, extracellular vesicles and coagulation in pulmonary arterial hypertension. Pulm Circ. 2021 Jun 4;11(3):20458940211021036. doi: 10.1177/20458940211021036
25. Kakar P, Lip GY. Hypertension: endothelial dysfunction, the prothrombotic state and antithrombotic therapy. Expert Rev Cardiovasc Ther. 2007;5(3):441-50. doi:10.1586/14779072.5.3.441
26. Amin H, Mohsin S, Aslam M, ve ark. Coagulation factors and antithrombin levels in young and elderly subjects in Pakistani population. Blood Coagul Fibrinolysis. 2012;23(8):745-50. doi:10.1097/MBC.0b013e328358e913