0356: Prognostic value of CHA2DS2-VASc score in patients with atrial fibrillation and valvular heart disease

Abstract

The CHA2DS2-VASc score estimates the risk of stroke in non-valvular atrial fibrillation (AF). Nonetheless, there are limited data on the risk of stroke/thromboembolic (TE) complications in AF patients with valvular heart disease, other than those with valvular prosthesis or rheumatic mitral valve disease. Methods Among 8962 patients with AF seen between 2000 and 2010, patients were categorised into Group 1 “non valvular AF” (n=6851; 78%), Group 2 “quasi valvular AF” ie. valve disease with neither rheumatic mitral stenosis nor valve prothesis (n=1202; 13%) and Group 3 “valvular AF” (n=909; 9%) using ESC AF guidelines definition. Results In group 2, 61% of the patients had mitral regurgitation (n=917, non severe in 52%, severe in 9%), 24% had aortic regurgitation (n=414, non severe in 22%, severe in 2%) and 32% had aortic stenosis (n=555, non severe in 18%, severe in 14%). In group 3, 88% of the patients with valvular AF had valve prostheses (n=797) and 14% had mitral stenosis (n=124). After follow up of 884±1084 days, 715 stroke/TE events were recorded. Group 2 was significantly older, had a higher CHA2DS2-VASc score and had a higher risk of TE events (relative risk 1.39; 95%CI 1.14–1.69) compared with Group 1. Severe valve disease was not associated with worse prognosis for stroke/TE events (relative risk 1.12, 95%CI 0.78–1.61). In the 3 groups, stroke/TE risk increased with a higher CHA2DS2-VASc score. Factors independently associated with increased risk of stroke/TE events were older age (RR 1.02, 95%CI 1.01–1.03) and higher CHA2DS2-VASc score (RR 1.33, 95%CI 1.23–1.45). The increased risk of stroke/TE events in patients from Group 2 (compared to those from Group 1) did not reach statistical significance in multivariate analysis. Conclusions In patients with AF, left-sided valvular heart disease (excluding mitral stenosis and protheses) was associated with an increased risk of stroke/TE events. A higher CHA2DS2-VASc score was the main driver of these events.