IJCS | Volume 32, Nº5, September/October 2019

DOI: 10.5935/2359-4802.20190073 Overall, one-third of thromboembolic events originated from the heart. Left atrial appendage (LAA) and its anatomic complexity has been implicated in 90% of cases of thrombus formation and cardioembolic events in patients with non-valvular atrial fibrillation (AF). Risk scores to predict thromboembolism from AF, such as CHADS 2 and CHA 2 DS 2 VASc are widely used to guide anticoagulation therapy 1 and varies in relation to comorbidities associated with the thrombogenic substrate; however, because of its clinical conception, they did not include atrial anatomy (atrial enlargement), function (flow velocities) and electrophysiology (atrial fibrillation burden). Patients with CHA 2 DS 2 VASc score ≥ 2 are at intermediate or higher risk (event rate ≥ 2-3%/year) and anticoagulation is recommended. Left atrial variables such as LAA function and morphology, routinely studied by transesophageal echocardiography (TEE), were not considered in these scores. In 2012, Di Biase et al.; 2 published a retrospective study of 932 patients withAF and computed tomography (CT)/magnetic resonance imaging (MRI) classification of four different types of LAA morphologies: chicken wing, cactus, windsock and cauliflower. Non-chicken wing categories were 4 to 8 times more likely to have had stroke/TIA. Eight additional cross-sectional studies utilizing this classification for LAAmorphology in 2,210 patients (6 with CT and 2 with TEE), found a significant association with non-chicken-wing morphology and stroke in 5 series 3-7 and no significant difference in 3 other studies. 8-10 In this issue of Int J Cardiovasc Sci, Linhares et al., 11 readdress the question of LAA morphology and stroke risk studying 237 patients with transesophageal echocardiography (TEE), the gold standard and most clinical utilized tool for thrombus detection in patients with LAA thrombosis/stroke risk. In this paper, the possibility of simple characterization with TEE patients with less-thrombogenic LAA anatomy (smooth internal surface and sharp angulation — “the chicken wing morphology”), was associated with less significant clinical events compared with patients with “thrombogenic non-chicken LAA morphology” (11.2% vs. 25.2% - p = 0.005). Because of the proximity of the esophagus to the left atrium, high-frequency transducers are able to acquire images of LA, especially LAA, using TEE, the test of choice for scanning these structures, with the possibility of detecting LAA trabeculations, pectinate muscles, number of LAA lobes, LAA velocities and thrombus. Additionally, its safety and semi-invasiveness make it the most sensitive and clinically useful diagnostic technique used for searching cardiac embolic sources, representing the mainstay of investigation in patients suspected to have cerebral embolism. LAA is the only part from the primitive left atrium (LA) and has pectinate muscle and trabeculations. Smoothness of LAA, prevalence of single lobes and acute angle bend (“chicken wing”) are the morphologic variables of LAA described as non-thrombogenic and may be reproducibly recognized by TEE. On the other 471 EDITORIAL International Journal of Cardiovascular Sciences. 2019;32(5):471-472 Mailing Address: Angelo A. V. de Paola R. Botucatu, 720. Postal Code: 04023-062, Vila Clementino, São Paulo, SP – Brazil. E-mail: depaola@uol.com.br; depaola@cardiol.br Risk Scores for Stroke Prevention in Patients with Non-Valvular Atrial Prevention: Is it Time to Put Parameters of Left Atrial Appendage Morphology and Function Into Clinical Practice? Angelo A. V. de Paol a Escola Paulista de Medicina - UNIFESP, São Paulo, SP – Brazil Editorial related to the article: Association between Morphodynamic Variables by Transesophageal Echocardiography and CHA 2 DS 2 -Vasc Values Stroke; Atrial Fibrillation; Atrial Apendage; Arrhytmias, Cardiacs; Myocardial Contraction; Echocardiography, Transesophageal. Keywords