Assessment of the ability of the CHA2DS2-VASc scoring system to grade left atrial function by 2D speckle-tracking echocardiography

• Published in: BMC cardiovascular disorders 2021-02, Vol.21 (1), p.1-94, Article 94
• Main Authors: Hadadi, Marjan, Mohseni-Badalabadi, Reza, Hosseinsabet, Ali
• Format: Article
• Language: English
• Subjects: Age; Atrial fibrillation; Care and treatment; CHA2DS2-VASc score; Complications; Complications and side effects; Contraction; Coronary artery; Coronary artery bypass; Coronary artery disease; Coronary heart disease; Diabetes; Disease; Echocardiography; Ejection fraction; Electrocardiography; Evaluation; Fasting; Fibrillation; Heart attacks; Heart failure; Heart function tests; Heart surgery; Hypertension; Left atrium; Mechanical ventilation; Mortality; Patients; Prognosis; Risk factors; Sinuses; Statistical analysis; Stroke; Surgery; Thromboembolism; Transient ischemic attack; Two-dimensional echocardiography; Two-dimensional speckle-tracking echocardiography; Ventilators; Womens health
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-021-01908-8

Background The CHA.sub.2DS.sub.2-VASc scoring system is correlated with left atrial (LA) reservoir function in patients with atrial fibrillation (AF) rhythm or paroxysmal AF. We assessed the ability of CHA.sub.2DS.sub.2-VASc to grade LA function in patients with sinus rhythm who were candidates for coronary artery bypass grafting (CABG). Methods This cross-sectional study recruited 340 consecutive candidates for CABG and categorized them according to their CHA.sub.2DS.sub.2-VASc scores as mild-, moderate-, and high-risk score groups with 34 (10%), 83 (24%), and 223 (66%) patients, respectively. LA function was evaluated via 2D speckle-tracking echocardiography in terms of global longitudinal strain and strain rate during the reservoir, conduit, and contraction phases. In-hospital mortality, postoperative AF, prolonged intensive care unit (ICU) stay, and prolonged mechanical ventilation were assessed. Results LA strain and strain rate during the reservoir phase was statistically significantly lower in the high-risk score group than the low- and moderate-risk score groups (27.8 [+ or -] 6.9% vs 31.0 [+ or -] 5.0% vs 29.8 [+ or -] 6.1%, respectively; P = 0.004 and 2.6 [+ or -] 0.7 s.sup.-1 vs 2.9 [+ or -] 0.6 s.sup.-1 vs 2.9 [+ or -] 0.6 s.sup.-1, correspondingly; P = 0.009) and regarding LA strain and strain rate during the conduit phase (9.7 [7.1-12.5]% vs 12.9 [9.4-15.1]% vs 11.5 [9.1-13.8]%, correspondingly; P < 0.001 and 2.1 [1.6-2.7] s.sup.-1 vs 2.8 [2.4-3.6] s.sup.-1 vs 2.6 [2.2-3.0] s.sup.-1, respectively; P < 0.001). In addition, LA strain rate during the conduit phase was lower in the moderate-risk score group than the low-risk score group. After adjustments for possible confounders, these differences remained statistically significant. The risk of postoperative AF and prolonged ICU stay was highest in the high-risk score group (relative risk = 9.67 (1.31-71.43) and 8.05 (1.08-60.16), respectively; P = 0.026 and P = 0.042, respectively). Conclusions LA reservoir and conduit functions decreased in the high-risk score group, which was accompanied by an increased risk of postoperative AF and prolonged ICU stay. Keywords: Left atrium, Coronary artery disease, Two-dimensional speckle-tracking echocardiography, CHA.sub.2DS.sub.2-VASc score