Novel Risk Score for Predicting Thrombogenic Milieu in NVAF Is Developed

Researchers have developed a novel risk score for the prediction of left atrial (LA) and left atrial appendage thrombogenic milieu (LAATM) in patients with nonvalvular atrial fibrillation (NVAF). And according to the researchers, the new score has higher accuracy than the CHADS₂ or CHA₂DS₂-VASc scoring systems.

“Although the CHADS₂ and CHA₂DS₂-VASc scoring systems are commonly used as measures of thromboembolic risk in patients with NVAF, data are inconsistent as to their value in predicting the presence of LA and/or LAATM,” the researchers wrote.

To develop a novel risk score to assess the risk of LA and/or LAATM in this patient population, the researchers evaluated data on 1223 patients with NVAF—125 of whom also had LA and/or LAATM—from January 1, 2010, to February 1, 2017.

Risk factors for LA and/or LAATM were identified. Based on results of a 10-fold validation with sequential methods, a risk score model was established. The score system (0-12) is based on 6 independent variables, each with its own point value:

• Point value of 1: 
  • Blood type A 
  • N-terminal B-type natriuretic peptide of 864.85 pg/ml or greater
• Point value of 2:
  • Left anterior descending artery of 43.5 mm or greater
  • Being aged 73.5 years or older
• Point value of 3: 
  • Previous heart failure
  • Previous stroke or transient ischemic attack

The newly developed risk score system had a sensitivity of 58.3%, a specificity of 91.4%, and an accuracy of 81.6%. 

“The negative predictive value was 92% when we set the cut-off point at 4,” the researchers concluded. “When the cut-off point was set at 8, the positive predictive value was 85.7%. Compared with CHADS₂ and CHA₂DS₂-VASc score, the present novel risk score has better predictive power.”

—Colleen Murphy

Reference:

Fu Y, Li K, Gao Y, Wang L, Chen M, Yang X. A novel risk score for predicting left atrial and left atrial appendage thrombogenic milieu in patients with non-valvular atrial fibrillation. Thromb Res. Published online May 10, 2020. doi:10.1016/j.thromres.2020.05.010