| Objective1. To explore the relationship between left atrial dimension (LAD) and CHADS2 score、CHA2DS2-VASc score in patients with NVAF;2. To explore the relationship between left atrial diameter index (LADI) and CHADS2 score、CHA2DS2-VASc score in patients with NVAF;3. To investigate the value of left atrial size measured by echocardiography in thromboembolic risk stratification of NVAF patients.Methods1. A retrospective, observational study was carried out. Inpatients diagnosed with non-valvular atrial fibrillation in Qilu hospital institution between 2010.01 and 2015.06 were included. Collect the clinical information of the cases and analyze the clinical character.;2. The stroke risk is assessed by CHADS2 score, CHA2DS2-VASC score;3. All subjects are divided into normal group and enlargement group according to the left atrial dimension,then compare the generalities, comorbidity, CHADS2 score and CHA2DS2-VASC score in different groups;4. All subjects are divided into normal group and enlargement group according to the left atrial diameter index (left atrial dimension divided by body surface area),then compare the generalities, comorbidity, CHADS2 score and CHA2DS2-VASC score in different groups.Result:1. This study included a total of 821 NVAF patients (40% female) at mean age of 66.32±12.84 years; patients with paroxysmal atrial fibrillation were 396(48.2%)cases, persistent AF were 230 (28%), permanent AF were195 (23.75%); patients with ischemic stroke were 108 (13.02%) cases.2. Of 821 NVAF patients mean CHADS2 score was 1.48 ±1.15points, as low risk group (0 score) in 162 (19.7%),moderate risk group (1 score) in 313 (38.1%) and high risk group (≥2 score) in 345 (42%)3. Of 821 NVAF patients mean CHA2DS2-VASc score was 2.69 ±1.63points, as low risk group (0 score) in 81 (9.9%). moderate risk group (1 score) in 124 (15.1%) and high risk group (≥2 score) in 616 (75%)4. Of 821 NVAF patients LAD normal in 284(34.6%) while enlarged in 152 (18.5%). Patients with enlarged LAD more often had history of hypertension, diabetes mellitus, ischemic heart disease, myocardial infarction and heart failure than patients with normal LAD(P<0.05), and had higher CHADS2,CHA2DS2-VASc score (1.61±1.11 vs.1.23±1.19, P<0.0001; 2.89±1.57vs.2.31±1.68, P<0.0001). After dividing patients into four categories:normal LAD, mildly, moderately, and severely enlarged LAD, we saw that along with the LAD also the risk in CHADS 2 and CHA2DS2-VAScscores rose.5. Of 821 NVAF patients LADI normal in 449 (54.7%) while enlarged in 372 (45.3%). Patients with enlarged LADI more often had history of ischemic heart disease, myocardial infarction and heart failure than patients with normal LADI(P< 0.05),and had higher CHADS2, CHA2DS2-VASc score (1.69±1.07 vs.1.31±1.19, P <0.0001; (3.16±1.44vs.2.30±1.68, P<0.0001).Then dividing patients into four categories, we also saw that both CHADS2 and CHA2DS2-VASc score increase with the increasing LADI.Conclusion:1. The enlargement of left atrial was highly prevalent in non paroxysmal atrial fibrillation patients, the bigger the left atrial size, the greater probability of persistent atrial fibrillation and basic diseases in patients with atrial fibrillation;2. Patients with LA enlargement have higher CHADS2 and CHA2DS2-VASc scores, mean CHADS2 and CHA2DS2-VASC scores rise with LA enlargement severity, the enlargement left atrial relates to a higher stroke risk assessed by both CHADS2 and CHA2DS2-VASc score; so enlargement LA can be used to identify patients with high risk of stroke and then guide anticoagulant therapy;3. Echocardiographically assessed LA size may be an additional parameter useful in thromboembolic risk stratification of NVAF patients. |
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