Can echocardiography improve the prediction of thromboembolic risk in atrial fibrillation? Evidences and perspectives
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IM - REVIEW
Can echocardiography improve the prediction of thromboembolic risk in atrial fibrillation? Evidences and perspectives Antonella Tufano1 · Maurizio Galderisi2 Received: 30 December 2019 / Accepted: 20 February 2020 © Società Italiana di Medicina Interna (SIMI) 2020
Abstract Atrial fibrillation is the most common arrhythmia and its prevalence is expected to further increase. Patients with atrial fibrillation have an increased risk of stroke (fivefold increased risk), heart failure, and death. In patients with non-valvular atrial fibrillation, the most recent guidelines recommend the use of the C HA2DS2-VASc (congestive heart failure, arterial hypertension, age > 75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65–74 years, sex category) scoring system to identify those who may benefit from oral anticoagulant treatment. Guidelines recommend initiation of oral anticoagulation with vitamin K antagonists or direct oral anticoagulants in men with a score ≥ 2 and in women with a score ≥ 3, while oral anticoagulation in individuals with a score of 0 is not recommended. Accordingly, men with CHA2DS2VASc score = 1 (and women with C HA2DS2VASc = 2) represent a grey zone where guidelines do not provide a definite oral anticoagulant indication. Implementation of risk stratification with transthoracic echocardiography could be extremely useful. Both prospective and observational studies using transthoracic echocardiography prediction of events and studies utilizing transesophageal echocardiographic parameters as surrogate markers of thromboembolic events make sustainable the hypothesis that echocardiography could improve thromboembolism prediction in non-valvular atrial fibrillation. However, because of some controversial results of different studies, determination of the best echocardiographic parameter predicting thromboembolic events in atrial fibrillation remains uncertain. The combination of left atrial enlargement with left atrial function (in particular assessing left atrial strain) appears to be very valuable, but needs to be confirmed in largescale multi-center trials. Keywords Non-valvular atrial fibrillation · Stroke · Systemic embolism · Echocardiography · Left atrium
Introduction Non-valvular atrial fibrillation (AF) is the most common cardiac arrhythmia and its prevalence is expected to further increase in the next future. Patients with AF have an increased risk of stroke (fivefold increased risk), heart failure, and death, and about 20–30% of all ischemic strokes are directly related to AF [1, 2]. Oral anticoagulation (OAC) is able to reduce the risk of ischemic stroke and systemic embolism in AF [3], but the protective effect against
* Antonella Tufano [email protected] 1
Department of Clinical Medicine and Surgery, Federico II University Hospital, Via S. Pansini, 5, 80131 Naples, Italy
Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
2
thromboembolic events (TE) needs to be balanced with the bleeding ris
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