The relationship between CHA2DS2-VA score and left atrial volumetric/mechanical coupling index in patients with paroxysmal atrial fibrillation

INTRODUCTION AND OBJECTIVE: This study aimed to investigate the relationship between the CHA₂DS₂-VA score and left atrial mechanical and electromechanical function parameters (LACI, Vp, Vmax, Vmin) in patients at risk for non-valvular atrial fibrillation. METHODS: A total of 117 patients diagnosed with PAF were categorized into three groups according to their CHA₂DS₂-VA scores: 0, 1, and ≥2. Transthoracic echocardiography was performed to assess LACI, Vmax, Vmin, Vp, and left atrial active, passive, and total volumes. Differences in these parameters among the three groups were compared. Independent predictors of high thromboembolic risk (CHA₂DS₂-VA ≥2) were evaluated using multivariate logistic regression analysis. Receiver Operating Characteristic (ROC) analysis was used to determine the discriminative ability of each parameter. RESULTS: Patients with CHA₂DS₂-VA ≥2 had significantly different values for LACI, Vmax, Vmin, Vp, and LA volume indices compared with the lower-risk groups (p<0.05). LACI demonstrated the strongest discriminative performance with an AUC of 0.750. Additional significant parameters included Vp (AUC: 0.728), Vmax (AUC: 0.709), Vmin (AUC: 0.696), and LA total volume (AUC: 0.726). In multivariate regression analysis, LACI (OR: 1.041, 95% CI: 1.016–1.066, p=0.001) and LA passive volume (OR: 1.096, 95% CI: 1.013–1.187, p=0.023) emerged as independent predictors of high-risk status. CONCLUSION: Echocardiographic markers of left atrial function such as LACI and tissue Doppler-derived parameters may serve as effective tools for identifying patients at higher thromboembolic risk. These markers could complement the CHA₂DS₂-VA clinical score in risk stratification for atrial fibrillation patients. A more comprehensive analysis of left atrial electromechanical properties may provide valuable insights for guiding clinical decision-making. Keywords: Atrial fibrillation, left atrial conduit index, left atrium, tissue Dopper imaging, thromboembolism