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This editorial refers to ‘Possible refinement of clinical thromboembolism assessment in patients with atrial fibrillation using echocardiographic parameters’ by R. Providencia et al., on page 36 Stroke risk assessment is key when determining the appropriate long-term antithrombotic therapy in patients with atrial fibrillation (AF). Over time many stroke risk stratification schema have been developed, initially with the objective to better define ‘high-risk’ patients who could be subjected to an inconvenient (and potentially dangerous) drug, warfarin.1Current European guidelines recommend the simple and commonly used CHADS2 as an initial assessment, which is then refined with a newer and more comprehensive assessment, the CHA2DS2-VASc score.1,2 The latter includes additional common clinical risk factors, and has shown to be better than the CHADS2 score in identifying ‘truly low-risk’ patients (who do not need any antithrombotic therapy) and is at least as good as—and possibly better than—the CHADS2 score in identifying ‘high-risk’ patients.3 Still, there may be sufficient room for improvement, given that some patients may have associated stroke risk factor on imaging, and indeed, echocardiography may even refine stroke risk stratification.4In this issue of Europace , Providencia et al .5 explore the potential benefit of adding echocardiography to the contemporary clinical stroke risk schema, CHADS2 and CHA2DS2-VASc. Their cross-sectional study consisted of 405 consecutive AF patients who underwent both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) without a significant time delay. After excluding patients with mitral valve stenosis or a prosthetic heart valve the remaining study population predominantly (352/376, …

europace

The role of echocardiography in stroke risk assessment in patients with atrial fibrillation: is it additive or does it simply echo clinical risk factors?