Association of MAPH and CHA₂DS₂-VASc Scores with Left Atrial Thrombus in Atrial Fibrillation Patients Undergoing Ablation: A Comparative Evaluation

Objective: This study aimed to compare the association of the MAPH score (Mean platelet volume–Age–Persistent atrial fibrillation–Hematocrit) and the CHA₂DS₂-VASc score (Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes mellitus, prior Stroke/transient ischemic attack (2 points), Vascular disease, Age 65–74 years, and Sex category (female)) with the presence of left atrial thrombus in patients undergoing atrial fibrillation ablation.
Method: This retrospective cross-sectional study included 258 consecutive patients with atrial fibrillation (AF) who underwent transesophageal echocardiography to assess thrombus status prior to ablation. Based on these findings, patients were categorized according to the presence or absence of left atrial (LA) thrombus.
Results: The mean age of the study population was 55.2 ± 11.7 years, and 53.5% of the participants were female. Patients with LA thrombus were more likely to have ongoing AF during TEE, mild mitral stenosis, elevated C-reactive protein (CRP) and international normalized ratio (INR) levels, and reduced ejection fraction. The median MAPH score was significantly higher in the thrombus group (p < 0.001). In multivariable analysis, ongoing AF (odds ratio [OR]: 3.83), anticoagulant therapy (OR: 14.95), elevated albumin (OR: 1328.5), elevated CRP (OR: 1.38), and elevated INR (OR: 9.09) were independently associated with thrombus presence. The MAPH score demonstrated superior discriminative performance compared to the CHA₂DS₂-VASc score for identifying LA thrombus (p = 0.014).
Conclusion: The MAPH score was significantly associated with LA thrombus and demonstrated superior discriminative ability compared to the CHA₂DS₂-VASc score for detecting LA thrombus. These findings suggest that the MAPH score may serve as a useful marker for identifying existing LA thrombus in patients with AF undergoing pre-procedural evaluation.

Keywords: Atrial fibrillation, left atrial thrombus, MAPH score, risk assessment