CHA(2)DS(2)-VASc Score as a Predictor for Left Atrial Thrombus or Spontaneous Echo Contrast in Patients with Nonvalvular Atrial Fibrillation: A Meta-Analysis

OBJECTIVE: This meta-analysis aimed at exploring the predictive value of CHA(2)DS(2)-VASc score for the left atrial thrombus (LAT) or left atrial spontaneous echo contrast (LASEC) in patients with nonvalvular atrial fibrillation (NVAF). METHODS: PubMed, Embase, Web of Science, ScienceDirect, Cochrane Library, and Chinese core journals of the CNKI and Wanfang databases were searched to identify all the relevant papers that were published up to January 2020. The data were extracted for pooled odds ratios (ORs) with 95% confidence intervals (CIs), heterogeneity, subgroup, publication bias, and sensitivity analysis. RESULTS: Overall, 15 studies containing 6223 patients with NVAF were enrolled. All studies were evaluated for LAT, and 12 studies were evaluated for LASEC. The pooled analysis using a random-effects model showed that a high CHA(2)DS(2)-VASc score was related with LAT/LASEC (pooled OR = 1.59, 95% CI: 1.35–1.88, P < 0.001) with high heterogeneity (I(2) = 76.9%, P < 0.001) and LAT (pooled OR = 1.83, 95% CI: 1.44–2.33, P < 0.001) with high heterogeneity (I(2) = 79.4%, P < 0.001). The subgroup analysis demonstrated that the sample size may be the main source of heterogeneity. Although the Begg's funnel plot based on 15 studies for LAT/LASEC (P = 0.029) and 12 studies for LAT (P = 0.046) indicated the presence of publication bias among the included studies, the trim-and-fill method verified the stability of the pooled outcomes. In addition, sensitivity analysis indicated that all effects were stable. CONCLUSION: The results of this meta-analysis showed that the CHA(2)DS(2)-VASc score is related with LAT and LASEC in patients with NVAF. However, more studies are warranted to address this issue.