Abstract
BackgroundThe CHA2DS2-VASc scoring system is correlated with left atrial (LA) reservoir function in patients with atrial fibrillation (AF) rhythm or paroxysmal AF. We assessed the ability of CHA2DS2-VASc to grade LA function in patients with sinus rhythm who were candidates for coronary artery bypass grafting (CABG).MethodsThis cross-sectional study recruited 340 consecutive candidates for CABG and categorized them according to their CHA2DS2-VASc scores as mild-, moderate-, and high-risk score groups with 34 (10%), 83 (24%), and 223 (66%) patients, respectively. LA function was evaluated via 2D speckle-tracking echocardiography in terms of global longitudinal strain and strain rate during the reservoir, conduit, and contraction phases. In-hospital mortality, postoperative AF, prolonged intensive care unit (ICU) stay, and prolonged mechanical ventilation were assessed.ResultsLA strain and strain rate during the reservoir phase was statistically significantly lower in the high-risk score group than the low- and moderate-risk score groups (27.8 ± 6.9% vs 31.0 ± 5.0% vs 29.8 ± 6.1%, respectively; P = 0.004 and 2.6 ± 0.7 s−1 vs 2.9 ± 0.6 s−1 vs 2.9 ± 0.6 s−1, correspondingly; P = 0.009) and regarding LA strain and strain rate during the conduit phase (9.7 [7.1–12.5]% vs 12.9 [9.4–15.1]% vs 11.5 [9.1–13.8]%, correspondingly; P < 0.001 and 2.1 [1.6–2.7] s−1 vs 2.8 [2.4–3.6] s−1 vs 2.6 [2.2–3.0] s−1, respectively; P < 0.001). In addition, LA strain rate during the conduit phase was lower in the moderate-risk score group than the low-risk score group. After adjustments for possible confounders, these differences remained statistically significant. The risk of postoperative AF and prolonged ICU stay was highest in the high-risk score group (relative risk = 9.67 (1.31–71.43) and 8.05 (1.08–60.16), respectively; P = 0.026 and P = 0.042, respectively).ConclusionsLA reservoir and conduit functions decreased in the high-risk score group, which was accompanied by an increased risk of postoperative AF and prolonged ICU stay.
Highlights
The CHA2DS2-VASc score is a scoring system that was first used for the risk assessment of cerebrovascular or thromboembolic events in patients with atrial fibrillation (AF)
The risk of postoperative AF and prolonged intensive care unit (ICU) stay was highest in the high-risk score
ICC, intraclass correlation coefficient; LAScd, left atrial longitudinal strain during the conduit phase; LASct, left atrial longitudinal strain during the contraction phase; LASr, left atrial longitudinal strain during the reservoir phase; pLASRcd, peak left atrial longitudinal strain rate during the conduit phase; pLASRct, peak left atrial longitudinal strain rate during the contraction phase; pLASRr, peak left atrial longitudinal strain rate during the reservoir phase the results of our study showed that was the CHA2DS2-VASc scoring system able to identify reduced LA reservoir and conduit functions in patients with high-risk scores (CHA2DS2-VASc scores ≥ 2 for men and ≥ 3 for women) and it was capable of identifying reduced LA conduit function in patients with moderaterisk scores compared with those with low- and high-risk scores
Summary
The CHA2DS2-VASc score is a scoring system that was first used for the risk assessment of cerebrovascular or thromboembolic events in patients with atrial fibrillation (AF). This scoring system allocates 1 point to each factor except for stroke, transient ischemic attack, and thromboembolism (2 points for each), and age (2 points allocated to age ≥ 75 years and 1 point to 65 < age < 74 years) [1] The application of this scoring system for the prediction of thromboembolic events is not restricted to patients with AF; it can be applied to patients without AF such as those with heart failure [2] or chronic obstructive pulmonary disease [3] and those after coronary artery bypass grafting (CABG) [4, 5]. We assessed the ability of C HA2DS2-VASc to grade LA function in patients with sinus rhythm who were candidates for coronary artery bypass grafting (CABG)
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