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Background <p>The predictive capacity of the CHA2DS2-VASc score for left atrial appendage thrombus (LAAT) detection in nonvalvular atrial fibrillation (NVAF) patients shows significant limitations.</p> Objective <p>To recognize predictors of LAAT and create a more precise risk-assessment model.</p> Methods <p>Between January 2019 and December 2023, consecutive NVAF patients without a previous history of anticoagulation who underwent transesophageal echocardiography were recruited from two centers. Clinical data, biomarker information, and transthoracic echocardiographic parameters were collected in a standardized manner. The derivation cohort comprised patients from one center, while the validation cohort consisted of participants from the other center.</p> Results <p>1505 patients (mean age 63.4±9.77 years; 895 male) were analyzed. LAAT was detected in 109 (7.24%) of the total 1505 patients. The final parameters selected for the LEFT-AF risk model included left atrial diameter (LAD), left ventricular ejection fraction (LVEF), history of heart failure (HF), history of stroke, and non-paroxysmal AF (NPAF). In the derivation cohort, the novel scoring system demonstrated superior discriminative performance compared to the currently used CHA2DS2-VASc score (0.693, 95% CI 0.634-0.752) (P&lt;0.001), CHA2DS2 score (0.679, 95% CI 0.621-0.731) (P&lt;0.001) and CLOTS-AF score (Creatinine&gt;1.5mg/dL, LVEF&lt;50%, LAVI&gt;34ml/m2, TAPSE&lt;17mm, Stroke, AF rhythm) (0.762, 95% CI 0.704-0.821), with an area under the receiver operating characteristic curve (AUC) of 0.855 (95% CI 0.808-0.902) (P&lt;0.001). This same superior performance was maintained in the validation cohort.</p> Conclusion <p>Among patients with NVAF who had not previously received anticoagulation therapy, the prevalence of LAAT was 7.24%. The LEFT-AF score improves LAAT risk stratification, particularly in patients with low CHA2DS2-VASc scores, potentially guiding anticoagulation decisions.</p> Graphical abstract <p></p>

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A new risk-stratified scoring system for predicting left atrial appendage thrombus in patients with nonvalvular atrial fibrillation

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月20日

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  • Junhao Liu,
  • Xuefeng Zhu,
  • Xiaobo Zheng,
  • Mengmeng Ren,
  • Yanyan Jing,
  • Hongxia Chu

摘要

Background

The predictive capacity of the CHA2DS2-VASc score for left atrial appendage thrombus (LAAT) detection in nonvalvular atrial fibrillation (NVAF) patients shows significant limitations.

Objective

To recognize predictors of LAAT and create a more precise risk-assessment model.

Methods

Between January 2019 and December 2023, consecutive NVAF patients without a previous history of anticoagulation who underwent transesophageal echocardiography were recruited from two centers. Clinical data, biomarker information, and transthoracic echocardiographic parameters were collected in a standardized manner. The derivation cohort comprised patients from one center, while the validation cohort consisted of participants from the other center.

Results

1505 patients (mean age 63.4±9.77 years; 895 male) were analyzed. LAAT was detected in 109 (7.24%) of the total 1505 patients. The final parameters selected for the LEFT-AF risk model included left atrial diameter (LAD), left ventricular ejection fraction (LVEF), history of heart failure (HF), history of stroke, and non-paroxysmal AF (NPAF). In the derivation cohort, the novel scoring system demonstrated superior discriminative performance compared to the currently used CHA2DS2-VASc score (0.693, 95% CI 0.634-0.752) (P<0.001), CHA2DS2 score (0.679, 95% CI 0.621-0.731) (P<0.001) and CLOTS-AF score (Creatinine>1.5mg/dL, LVEF<50%, LAVI>34ml/m2, TAPSE<17mm, Stroke, AF rhythm) (0.762, 95% CI 0.704-0.821), with an area under the receiver operating characteristic curve (AUC) of 0.855 (95% CI 0.808-0.902) (P<0.001). This same superior performance was maintained in the validation cohort.

Conclusion

Among patients with NVAF who had not previously received anticoagulation therapy, the prevalence of LAAT was 7.24%. The LEFT-AF score improves LAAT risk stratification, particularly in patients with low CHA2DS2-VASc scores, potentially guiding anticoagulation decisions.

Graphical abstract