Abstract 20254: Left Atrial Dimensions Can Help in Predicting Thromboembolic Risk in Non Valvular Atrial Fibrillation Patients Treated With Direct Oral Anticoagulants

IntroductionThe discriminative ability of the widely used CHA2DS2-VASc score for thromboembolic risk stratification in non valvular atrial fibrillation (NVAF) is known as modest, thus, it would be useful to have additional parameters to stratify it.HypothesisOn the basis of pathophysiology of atrial thromboembolism, we assessed, in a real-world population of NVAF patients treated with direct oral anticoagulants (DOACs), the association between CHA2DS2-VASc, simple echocardiographic parameters such as left atrial antero-posterior diameter and left atrial volume and thromboembolic risk.MethodsWe evaluated CHA2DS2-VASc score and following variables assessed with 2D transthoracic echocardiographyleft atrial end-systolic antero-posterior diameter (LA diameter) and left atrial volume index (LAVI). We evaluated also 1-year incidence of ischemic stroke, TIA or arterial embolism. Statistical analysis was performed using simple linear regression and logistic regression.ResultsOf 273 patients (129 treated with apixaban, 120 treated with dabigatran and 24 treated with rivaroxaban), the mean age was 73.1 ± 10.6 years and 152 (55.7 %) were males. Mean CHA2DS2-VASc was 3.7 ± 1.7. Mean values of echocardiographic parameters wereLA diameter 45.3 ± 6.7 mm, LAVI 38.3 ± 10.9 mL. After 1 year of follow up, 6 patients (2.19 %) had ischemic stroke, TIA or arterial embolism. Linear regression analysis showed statistically significant association only between CHA2DS2-VASc and LAVI (β 0.202; p = 0.001). Logistic regression analysis showed no statistically significant association between CHA2DS2-VASc and 1-year incidence of ischemic stroke, TIA or arterial embolism. However, significant associations between LA diameter, LAVI and 1-year incidence of ischemic stroke, TIA or arterial embolism were observed (p respectively 0.004 and 0.009). The OR for thromboembolic events increased by 1.28 for each unit increase in LA diameter and by 1.089 for each unit increase in LAVI.ConclusionsEchocardiographic data such as left atrial anteroposterior diameter and left atrial volume index can be useful parameters, in addition to CHA2DS2-VASc score, in thromboembolic risk stratification for a better management of anticoagulant therapy in patients with NVAF.