Abstract
BackgroundThe CHADS2/CHA2DS2-VASc scores are used to predict thrombo-embolic/stroke in patients with nonvalvular atrial fibrillation (AF). Nevertheless, limited data are available regarding the association between these risk stratification for stroke and left atrial (LA) remodeling status of AF patients. The purpose of this study was to explore the association between these scores and LA remodeling status assessed quantificationally by echocardiography in AF patients.MethodsOne hundred AF patients were divided into 3 groups based on the CHA2DS2-VASc/CHADS2 score: the score of 0 (low stroke risk), the score of 1 (moderate stroke risk) and the score of ≥2 (high stroke risk). All patients were performed through conventional and velocity vector imaging echocardiography. Echocardiographic parameters: maximum LA volume index (LAVImax), LA total emptying fraction (LAEFt) and LA mean strain were obtained to assess quantificationally LA remodeling status.ResultsOn categorizing with CHA2DS2-VASc, the score of 1 group showed augment in LAVImax and attenuation in LA mean strain derived from VVI, compared with the score of 0 group (LAVImax: 40.27±21.91 vs. 26.79±7.87, p=0.002; LA mean strain: 15.18±6.36 vs. 22±8.54, p=0.001). On categorizing with the CHADS2 score, similar trends were seen between the score of ≥2 and 1 groups (LAVImax: 43.72±13.77 vs. 31.41±9.50, p<0.001; LA mean strain: 11.01±5.31 vs. 18.63±7.00, p<0.001). With multivariate logistic regression, LAVImax (odds ratio: 0.92 , 95% C=I: 0.85 to 0.98, p= 0.01) and LA mean strain reflecting LA remodeling (odds ratio: 1.10, 95% CI: 1.02 to 1.19, p=0.01) were strongly predictive of the CHA2DS2-VASc score of 0.ConclusionsThe superiority of the CHADS2 score may lay in identifying LA remodeling of AF patients with high stroke risk. Whereas, the CHA2DS2-VASc score was better than the CHADS2 score at identifying LA remodeling of AF patients presenting low stroke risk.
Highlights
Atrial fibrillation (AF) is one of the most common arrhythmias in clinical practice [1]
To stratify thrombo-embolic risks in patients with nonvalvular atrial fibrillation (AF) and to identify patients eligible for anticoagulation, two stroke risk stratification schemes have been widely applied in clinical practice, including the CHADS2 score (Congestive heart failure, Hypertension, Age ≥75, Diabetes, Stroke [doubled]) [3] and the CHA2DS2-VASc score (Congestive heart failure, Hypertension, Age ≥75 [doubled], Diabetes, Stroke [doubled], Vascular disease, Age 65–74, and Sex category [female]) [4]
There was no statistical difference in duration of AF, lab parameters
Summary
Atrial fibrillation (AF) is one of the most common arrhythmias in clinical practice [1]. Precise assessment of LA remodeling could improve our ability to predict the risk of developing stroke and the response to treatments in patients with this arrhythmia [7]. Compared with pure conventional echocardiograph, the combination of velocity vector imaging (VVI) and conventional echocardiograph could offer more comprehensive echocardiographic parameters quantificationally reflecting status of LA remodeling, such as atrial volume, ejection fraction and strain [7,8,9,10]. The CHADS2/CHA2DS2-VASc scores are used to predict thrombo-embolic/stroke in patients with nonvalvular atrial fibrillation (AF). The CHA2DS2-VASc score was better than the CHADS2 score at identifying LA remodeling of AF patients presenting low stroke risk
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