ĐÁNH GIÁ VAI TRÒ CỦA THANG ĐIỂM CLOTS-AF TRONG DỰ ĐOÁN HUYẾT KHỐI TIỂU NHĨ TRÁI Ở BỆNH NHÂN RUNG NHĨ

Abstract

Objective: To evaluate the role of the CLOTS-AF score in predicting left atrial appendage thrombus (LAAT) in patients with atrial fibrillation (AF). Methods: A cross-sectional descriptive study was conducted on 149 AF patients undergoing transesophageal echocardiography (TEE). Clinical and paraclinical characteristics were compared between groups with and without LAAT. Receiver Operating Characteristic (ROC) curve analysis was used to assess the predictive performance of the CLOTS-AF score. Results: Of 149 patients, 18 (12.1%) had LAAT on TEE. Predictors of LAAT included: Shorter duration of anticoagulant therapy (OR 0.733, 95% CI 0.593–0.907, p=0.004), heart failure with LVEF <50% (OR 4.267, 95% CI 1.455–12.515, p=0.008), use of mineralocorticoid receptor antagonists (MRA) (OR 3.532, 95% CI 1.223–10.199, p=0.02) and use of furosemide (OR 3.353, 95% CI 1.111–10.119, p=0.032). In multivariate regression, shorter anticoagulant therapy duration remained an independent predictor (OR 0.648, 95% CI 0.491–0.854, p=0.002). The CLOTS-AF score demonstrated superior predictive ability with an AUC of 0.696 (95% CI 0.562–0.830, p=0.007). At a cutoff of ≥3.5, it achieved a sensitivity of 50% and specificity of 82.4%, outperforming other scores at similar thresholds. Conclusion: The CLOTS-AF score is a useful tool for predicting LAAT in AF patients, particularly in settings where routine TEE is not feasible, aiding clinical decision-making. However, its sensitivity at the optimal cutoff is limited, necessitating further research to improve and validate it in larger populations.