IJCS | Volume 32, Nº5, September/October 2019

DOI: 10.5935/2359-4802.20190017 460 ORIGINAL ARTICLE International Journal of Cardiovascular Sciences. 2019;32(5):460-470 Mailing Address: Renata Rejane Linhares Rua Vergueiro, 7165, apartment: 173. Postal Code: 04273-100, Vila Firmiano Pinto, São Paulo, SP - Brazil. E-mail: relinhares1977@gmail.com Association between Morphodynamic Variables by Transesophageal Echocardiography and CHA 2 DS 2 -Vasc Values Renata Rejane Linhares, 1 D almo Antonio Ribeiro Moreira, 2 L uciana Braz Peixoto, 1 A ndresa Paes da Cruz, 1 Luara Piovam Garcia, 1 Rodrigo Bellio de Mattos Barretto, 1, 2 D avid Costa de Souza Le Bihan, 1, 2 C arlos Eduardo Suaide Silva 1 DASA - Diagnósticos da América S/A, 1 São Paulo, SP - Brazil Instituto Dante Pazzanese de Cardiologia, 2 São Paulo, SP - Brazil Manuscript received June 26, 2018; revised manuscript September 02, 2018; accepted November 01, 2018. Abstract Background: In atrial fibrillation (AF), the CHA 2 DS 2 -VASc score calculates the risk for stroke. Di Biase classified the left atrial appendage (LAA), using magnetic resonance imaging, into 4 morphological types and correlated it with cerebrovascular events. Transesophageal echocardiography (TEE) also evaluates LAA and is a more widespread technique. Objective: To evaluate, using TEE, the possibility of characterizing LAA and to analyze its morphological aspects using the CHA 2 DS 2 VASc score. Method: A total of 247 patients were divided into three groups considering the CHA 2 DS 2 -VASc score: Group 1: 0 and 1; Group 2: 2 and 3 and, Group 3: ≥ 4 points. TEE produced the echocardiographic data. LAA was classified into thrombogenic and non-thrombogenic morphologies. In the analysis of statistical tests, a significance level of 5% was adopted. Results: The average age was 50 and 16.2% presented AF. In Group 1, we observed normal variables with a lower prevalence of AF (8.7%, p < 0.001). In group 2, spontaneous contrast was detected in 26.7%, (p < 0.001), thrombus in 6.7% (p = 0.079) and flow velocity in LAA < 0.4 m/s in 22.7% (p < 0.001) of the cases. Group 3 presented the highest percentages of AF (31.8%, p < 0.001), stroke/TIA (77.3%, p < 0.001), EF < 55% (18.2%, p = 0.010) and higher prevalence of thrombogenic type LAA (72.7%, p = 0.014). A higher occurrence of stroke/TIA was observed in patients with thrombogenic LAA (25.2%) compared to the non-thrombogenic group (11.2%), (p = 0.005). Conclusions: The thrombogenic morphology of LAA identified in TEE presented a higher risk of stroke regardless of the CHA 2 DS 2 VASc score. Patients with higher scores had greater abnormalities in echocardiographic variables. (Int J Cardiovasc Sci. 2019;32(5):460-470) Keywords: Stroke; Atrial Fibrillation, Atrial Appendage, Arrhythmias, Cardiac; Myocardial Contraction; Echocardiography, Transesophageal. Introduction Stroke is the leading cause of death in Brazil and the heart is an important embolic source responsible for this complication. Atrial fibrillation accounts for 20% of stroke cases. The treatment of this arrhythmia is an important challenge for the medical community. In addition to reestablishing sinus rhythm or not, or only performing ventricular rate control, anticoagulant therapy is definitely the one that improves the prognosis of affected patients. 1,2 The recommendation of anticoagulation is objectively performed by characterizing the individual risk of systemic thromboembolism based on the CHA 2 DS 2 VASc score (C = heart failure; H = hypertension; A = age > 75 years; D = diabetes mellitus; S = history of stroke; V = peripheral vascular disease; A = age above 64 years; S = female sex). Age > 75 years and history of stroke generate two points in the score while the other variables generate only one point. Higher risk for