Дополнительные критерии стратификации риска ишемического инсульта у пациентов с фибрилляцией предсердий и одним не связанным с полом баллом по шкале CHA2DS2-VASс обусловленным артеиальной гипертонией

Abstract

Purpose. Identification of characteristics, not included in the CHA2DS2-VASc scale, affecting the risk of ischemic stroke in patients with atrial fibrillation (AF) and one non-sex-related risk factor (RF), due to arterial hypertension (AH), of thromboembolic events on this scale. Methods. A “case-control” study was conducted according to retrospective analysis of medical records of patients with AF. The main group included hospitalized due to development of ischemic stroke patients with non-valvular AF and single additional to gender RF on the CHA2DS2-VASc scale due to AH in the period prior to the stroke development. As a comparison group, patients with comparable demographic characteristics, having non-valvular AF with single additional to gender RF on the CHA2DS2-VASc scale due to AH and no history of stroke or systemic embolism, were selected. Anamnesis data and the results of electrocardiography, echocardiography and ultrasonic duplex scanning of brachiocephalic arteries were analyzed. Results. The main group included 37 patients, age 60.15 (±6,21) years, 27% women. The control group included 88 patients, age 60.13 (±4,85) years, 37.58% women. Patients of the main group, compared to the control group patients, significantly more often showed permanent AF (48.7% and 14.3%, p = 0.01), signs of left ventricular hypertrophy (LVH) according to echocardiography (67.6% and 43.6% , p = 0.026), and thickening of the intima-media complex (cIMT) > 0.9 mm (73% and 25%, p <0.0001) according to ultrasonic duplex brachiocephalic arteries scanning. The univariate analysis showed a significant increase of ischemic stroke risk in the presence of a permanent AF (odds ratio (OR) 5.28; 95% confidence interval (CI) 1,15 - 6,94), LVH according to echocardiography (OR 2.81, 95% CI 1.15 - 6.91) and cIMT thickening (OR 7.88, 95% CI 2.96 - 20.94). Conclusion. When assessing the risk of ischemic stroke and making the decision on the oral anticoagulants appointment in patients with atrial fibrillation and single additional to gender risk factor on the CHA2DS2-VASc scale due to AH, in which the indications for anticoagulant therapy are not absolute, it is advisable to consider the data of echocardiography, ultrasonic duplex scanning of brachiocephalic arteries and the form of AF.