The Correlation between Left Atrial Deformation Indices and the CHA2DS2 -VASc Risk Score in Patients with Atrial Fibrillation

Objectives: To assess the relation between left atrial systolic strain and CHA2DS2 -VASc score in patients with non valvular atrial fibrillation and to assess whether it can be used in guiding the decision for oral anticoagulation. Methods: The study included 100 patients with non- valvular persistent AF (group I) compared to 100 individuals with sinus rhythm of matching age and gender (group II). Standard two-dimensional echocardiography, PW Doppler and TDI derived velocity and strains were used to assess LA function then its correlation with CHA2DS2-VASc score in group I was evaluated. Results: The prevalence of DM (P<0.001), HTN (P=0.001), prior stroke (P<0.001), heart failure (P < 0.001) and peripheral vascular disease (P < 0.001) was increased in patients in group I. Group I showed significant increase in LA diameters (anterio-posterior, transverse and longitudinal) P E‚ 0.001, LA volumes (maximal and minimal P < 0.001 and mitral E/e" ratio P E‚ 0.05. The correlation between LA emptying fraction and CHA2DS2 - VASc score was negative and significant (P < 0.05). Systolic LA strain was significantly reduced in patients with AF (P < 0.001) and it was negatively correlated to CHA2DS2 - VASc score but without statistical significance. There was no significant difference of LA systolic strain between the CHA2DS2 - VASc score of < 2 points and ≥ 2 points (P = 0.52). Systolic LA strain ≤ 17.44 was shown to have the best diagnostic accuracy (sensitivity = 42.11 %; specificity = 62.07%) in predicting CHA2DS2 - VASc ≥ 2. Conclusion: LA systolic strain is significantly reduced in AF patients and negatively correlated to CHA2DS2- VASc score and no significant difference between LA systolic strain in patients with CHA2DS2 - VASc score of < 2 points and ≥ 2 points so LA strain may be a tool that helps in guiding the decision for oral anticoagulation.