Usefulness of the uric acid and CHA(2)DS(2)-VASc score in prediction of left atrial thrombosis in patients with mitral stenosis and sinus rhythm

Abstract

Background: The risk of thrombus formation in the left atrium is known to be very high in patients with both mitral stenosis (MS) and atrial fibrillation (AF). However, that risk should not be ignored in patients with MS in sinus rhythm (SR). The aim of this study was to determine the clinical, echocardiographic, and biochemical factors that could have a determining role in the formation of a left atrial (LA) thrombus in patients with MS in SR. Method: A total of 207 consecutive patients with MS who underwent both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) for diagnosis or to investigate the presence of a thrombus in the LA and appendage were enrolled in this study. Results: LA thrombus was detected in 21 of 207 patients. CHA(2)DS(2)-VASc score was not found to be a predictor of LA thrombosis in patients with MS in SR, despite the higher CHA(2)DS(2)-VASc scores observed in those patients. The mitral valve area and mitral valve gradient were not predictive of LA thrombus development; however, LA anteroposterior diameter (LAAPD) was found to be a predictor of LA thrombosis. Levels of high sensitivity-C-reactive protein and uric acid were higher in the patients with LA thrombosis, but only uric acid was found to be a predictor of LA thrombosis in multivariate analysis. Conclusions: A larger LAAPD and an elevated serum uric acid level were found to be independent predictors of LA thrombosis in patients with MS in SR.