Evaluation of Left Atrial Remodeling in Patients with Sinus Rhythm and Higher CHA2DS2-VASc Scores: A Speckle-Tracking Echocardiography Study

Background The CHA₂DS₂-VASc score is widely used to estimate embolic risk and guide anticoagulation in atrial fibrillation (AF). Functional and structural atrial remodeling plays a central role in AF development and persistence. Early detection of remodeling in high-risk patients may enable targeted management of modifiable factors and reduce AF-related morbidity. Echocardiographic evaluation of left atrial (LA) structure and function can help identify subclinical dysfunction in individuals with elevated CHA₂DS₂-VASc scores, even before AF onset. Methods We studied 149 patients in sinus rhythm with a CHA₂DS₂-VASc score ≥ 2 and no prior AF. Patients were divided into two groups: scores 2–4 (n = 79) and 5–9 (n = 70). Comprehensive echocardiography assessed LA diameters, areas, volumes, phasic function, and strain parameters, with comparisons between groups. Results The high-score group showed significantly larger LA volumes and reduced functional indices, including total emptying fraction, LA ejection fraction, expansion index, and active emptying fraction. Strain analysis revealed lower reservoir (LASr), conduit (LAScd), and contraction strain (LASct) in patients with higher scores. LA stiffness (LAst) was significantly increased (p < 0.05). Multivariate logistic regression identified LAst as the strongest independent predictor of higher CHA₂DS₂-VASc scores (OR: 4.816; 95% CI: 1.45–15.99; p = 0.01). Conclusions Patients with higher CHA₂DS₂-VASc scores demonstrate pronounced structural, functional, and mechanical LA remodeling, despite absence of AF. Among assessed parameters, LAst was the most powerful predictor of elevated risk, highlighting its potential as a novel echocardiographic biomarker for early detection of atrial remodeling and improved thromboembolic risk stratification.