Volume 32, Nº 5, September and October 2019

DOI: http://www.dx.doi.org/10.5935/2359-4802.20190073

EDITORIAL

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?

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 CHADS₂ and CHA₂DS₂VASc are widely used to guide anticoagulation therapy¹ 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 CHA₂DS₂VASc 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.

Keywords: Stroke; Atrial Fibrillation; Atrial Apendage; Arrhytmias, Cardiacs; Myocardial Contraction; Echocardiography, Transesophageal.