IJCS | Volume 32, Nº5, September/October 2019

468 Table 3 - Distribution of patients by spontaneous contrast, thrombus and stroke/TIA, according to LAA type LAA groups Thrombogenic Non-thrombogenic Total N % N % N % Spontaneous contrast 131 100.0% 116 100.0% 247 100.0% Yes 20 15.3% 14 12.1% 34 13.8% No 111 84.7% 102 87.9% 213 86.2% ᵪ 2 (1, N = 247) = 0.53 - p = 0.467 Presence of thrombus 131 100.0% 116 100.0% 247 100.0% Yes 5 3.8% 2 1.7% 7 2.8% No 126 96.2% 114 98.3% 240 97.2% Fisher’s exact test - p = 0.453 Stroke/TIA 131 100.0% 116 100.0% 247 100.0% Yes 33 25.2% 13 11.2% 46 18.6% No 98 74.8% 103 88.8% 201 81.4% ᵪ 2 (1, N = 247) = 7.94 - p = 0.005 TIA: transient ischemic attack; LAA: left atrial appendage. Linhares et al. Transesophageal echocardiography and CHA2DS2-Vasc score Int J Cardiovasc Sci. 2019;32(5):460-470 Original Article In our study, after an analysis of 247 patients without primary valvopathy who underwent transesophageal echocardiography in an outpatient setting, 207 in sinus rhythm and 40 with history of AF, there was an association of all echocardiographic data analyzed (spontaneous contrast, left atrial dimensions, ejection fraction and blood flow velocity in LAA) with the CHA 2 DS 2 -Vasc score, except for the presence of atrial thrombus (p = 0.079). These findings confirm our initial suspicion that individuals with a high-risk score, even in sinus rhythm, already have important structural and functional cardiac changes that could be the future substrate for thrombus formation. Willens et al. retrospectively analyzed 167 patients undergoing TEE, with a mean age of 66 years and non- valvular AF. These authors described an increase in the prevalence of risk factors for thromboembolism the higher the CHA 2 DS 2 -VASc score. 15 Another study, published by Parikh et al., 16 presented a retrospective analysis of 455 patientswith atrial flutterwhounderwent transesophageal echocardiography. This group found that the sensitivity for the presence of thrombus and spontaneous contrast in patients classified as high risk in the CHADS 2 and CHA 2 DS 2 -VASc scores was 64.8%and 88.7%, respectively (p = 0.0001), and the specificity 52.6% and 28.9%, respectively (p = 0.0001). Both the CHA 2 DS 2 -VASc and the CHADS 2 score are useful for the stratification of stroke risk in other clinical situations, such as atrial flutter. The CHA 2 DS 2 -VASc protocol had greater sensitivity for the detection of atrial thrombosis and spontaneous contrast at the expense of reduced specificity. 16 In our study, when we considered only those with AF, we identified a greater presence of spontaneous contrast compared to the group that was in sinus rhythm (67.5% x 3.4%, p < 0.001), higher chances of mild, moderate and severe atrial dilation (35%, 32.5%, 10% vs 9.7%, 3.4% and 0.5%, respectively, p < 0.001). There was also a valid association with thrombus in the presence of this arrhythmia (17.5%, p < 0.001). Morphologyof LAAand riskof thromboembolism and stroke LAA is one of the main sources of cardiac thrombi responsible for cerebrovascular thrombotic events in patients with AF. 3-6 Di Biase et al., 3 through magnetic