CHA2DS2-VASc Score In Patients Research Articles

Associations between stroke risk factors and left atrial low-voltage areas in patients with atrial fibrillation undergoing catheter ablation from the REAL-AF registry

Abstract Background Prior research indicates that increased left atrial low-voltage areas (LA LVA) are linked to comorbidities and CHA2DS2-VASc score in patients with persistent atrial fibrillation (PerAF) undergoing catheter ablation. However, given the heterogeneity of AF where patients may transition between paroxysmal AF (PAF) and PerAF types, it is biologically plausible that these associations span all forms of AF. Purpose To investigate the relationship of stroke demographics and comorbidities to LA LVA and AF type in a multicenter registry of patients undergoing catheter ablation. Methods The Real-world Experience of Catheter Ablation for the Treatment of Symptomatic PAF and PerAF Using Novel Contact Force Technologies registry (REAL-AF) is a prospective, observational multicenter registry of patients undergoing catheter ablation. We evaluated 6053 patients undergoing first-time catheter ablation for both PAF and PerAF to identify associations between stroke risk factors and LA LVA. LA LVA was determined in contact maps as bipolar voltage <0.50 mV. Mapping was completed using 5-spline high-density catheters before ablation. LA LVA was categorized into low (<5%) vs. high (≥5%) based on preliminary data. Analyses were conducted using independent samples t-test and Chi-square test. Results LA LVA was associated with greater CHA2DS2-VASc score (3.2 vs. 2.5, p <0.001). Age 75+ (Odds ratio (OR): 2.22, p<0.001), congestive heart failure (CHF) (OR: 2.01, p<0.001), female sex (OR): 1.51, p<0.001), vascular disease (OR: 1.50, p<0.001), age 65-74 (OR: 1.20, p=0.001), hypertension (OR: 1.38, p<0.001), history of stroke (OR: 1.29, p=0.004) and diabetes (OR: 1.25, p=0.001) were also associated with LA LVA (Table 1). These associations remained significant among a subgroup of those presenting in normal sinus rhythm (N = 3546). Patients with CHF (OR: 2.09, p<0.001), hypertension (OR: 1.89, p<0.001) and male sex (OR: 0.60, p<0.001) were more likely to have PerAF in the LVA ≥5% subgroup (n=1594) (Table 2). All other components of the CHA2DS2-VASc score were not significantly associated with AF type in this subgroup. While there was a significant association between AF type and CHA2DS2-VASc score (PAF: 3.15, PerAF: 3.42, p<0.001) in the LA LVA ≥5% subgroup, the effect size was small (Cohen’s d = -0.179). Conclusion LA LVA ≥5% was associated with all separate components and overall CHA2DS2-VASc score. In patients with LA LVA ≥5%, there were only associations between PerAF and CHF, hypertension, and male sex, implying a special role in substrate progression. Our findings suggest that LA LVA may represent a more sensitive clinical phenotyping tool of AF rather than current duration-based ones. This is the largest study to our knowledge in elucidating the relationship between increased LA LVA and stroke risk factors in the AF population.

CHA2DS2-VASc Score for Predicting the Risk of Contrast-Induced Nephropathy After Transcatheter Aortic Valve Replacement

Contrast induced nephropathy (CIN) is a condition that can develop due to percutaneous cardiac interventional procedures and can adversely affect the prognosis of patients. The CHA2DS2-VASc score has been shown to be an independent predictor of acute kidney injury (AKI) and indicates an unfavorable prognosis in patients with acute coronary syndrome. Knowledge of the risk of AKI prior to transaortic valve replacement (TAVR) may help to reduce the rate of AKI. Therefore, we aimed to evaluate the utility of CHA2DS2 VASC score in patients undergoing TAVR.

Arrhythmias and Device Therapies in Cardiac Amyloidosis.

Cardiac amyloidosis is caused by amyloid fibrils that deposit in the myocardial interstitium, causing restrictive cardiomyopathy and eventually death. The electromechanical, inflammatory, and autonomic changes due to amyloid deposition result in arrhythmias. Atrial fibrillation is by far the most common arrhythmia. The rate control strategy is generally poorly tolerated due to restrictive filling physiology and heart rate dependance, favoring adoption of the rhythm control strategy. Anticoagulation for stroke prophylaxis is warranted, irrespective of CHA2DS2-VASc score in patients with a favorable bleeding profile; data on left appendage closure devices are still insufficient. Ventricular arrhythmias are also not uncommon, and the role of implantable cardioverter-defibrillator in cardiac amyloidosis is controversial. There is no evidence of improvement in outcomes when used for primary prevention in these patients. Bradyarrhythmia is most commonly associated with sudden cardiac death in cardiac amyloidosis. Pacemaker implantation can help provide symptomatic relief but does not confer mortality benefit.

Evaluation of the Relationship between Cognitive Impairment and Atria Score Systems in Patients with Atrial Fibrillation.

Atrial fibrillation (AF) is the main arrhythmia associated with thromboembolic complications and cognitive impairment. In this study, we aimed to evaluate the relationship between cognitive impairment and different scoring systems developed for AF to improve the medical follow-up of cognitive impairment. Between January 2019 and December 2020, 124 patients between the age of 30 and 80 years, diagnosed with AF for at least 5 years and complaining about memory impairment during cardiological follow-up, were included in the study. The patients were divided into two groups based on their cognitive status as assessed by the Mini-Mental State Examination group 1 consisted of 52 patients with cognitive impairment and group 2 comprised 72 patients without cognitive impairment. The ATRIA bleeding score had a positive moderate correlation (r = 0.454, P < 0.001), the ATRIA stroke score had a strong correlation (r = 0.738, P < 0.001), and the SAMe-TT2R2 score had a strong correlation (r = 0.688, P < 0.001) with cognitive impairment. However, CHADS2 and CHA2DS2VASc scores were not statistically correlated with cognitive impairment. According to the receiver operating characteristic (ROC) curve, the area under the curve (AUC) of the ATRIA bleeding score was 0.761 with a 95% confidence interval (CI) of 0.678-0.844 and P < 0.001; also, for the ATRIA stroke score, AUC was 0.930 with a 95% CI of 0.886-0.974 and P < 0.001. In addition, for the SAMe-TT2R2 score, AUC was 0.895 with a 95% CI of 0.838-0.952 and P < 0.001. In the pairwise comparison of AUC on ROC curves, the ATRIA stroke score and the SAMe-TT2R2 score were statistically similar (P = 0.324). ATRIA bleeding, ATRIA stroke, and SAMe-TT2R2 scores were greater than CHADS2 stroke score (P: 0.0004, P < 0.0001, and P < 0.0001, respectively), but CHA2DS2-VASc and CHADS2 stroke scores were statistically similar (P: 0.402). Both ATRIA stroke and SAMe-TT2R2 scoring systems can provide a better correlation than CHADS2 and CHA2DS2-VASc scores in patients with AF to evaluate their cognitive status. These two scores can be more useful to monitor the patients with AF for medical follow-up of cognitive status.

Correlation between the severity of coronary artery disease and CHA2DS2VASc Score in patients with non-valvular atrial fibrillation

Correlation between the severity of coronary artery disease and CHA2DS2VASc Score in patients with non-valvular atrial fibrillation

CHA2DS2-VASc score, P-wave indexes, and echocardiographic parameters in sinus rhythm patients without valvular heart disease.

The aim of this study was to evaluate the correlation between P-wave indexes, echocardiographic parameters, and CHA2DS2-VASc score in patients without atrial fibrillation and valvular disease. This retrospective cross-sectional study included patients of a tertiary hospital with no history of atrial fibrillation, atrial flutter, or valve disease and collected data from June 2021 to May 2022. The exclusion criteria were as follows: unavailable medical records, pacemaker carriers, absence of echocardiogram report, or uninterpretable ECG. Clinical, electrocardiographic [i.e., P-wave duration, amplitude, dispersion, variability, maximum, minimum, and P-wave voltage in lead I, Morris index, PR interval, P/PR ratio, and P-wave peak time], and echocardiographic data [i.e., left atrium and left ventricle size, left ventricle ejection fraction, left ventricle mass, and left ventricle indexed mass] from 272 patients were analyzed. PR interval (RHO=0.13, p=0.032), left atrium (RHO=0.301, p<0.001) and left ventricle diameter (RHO=0.197, p=0.001), left ventricle mass (RHO=0.261, p<0.001), and left ventricle indexed mass (RHO=0.340, p<0.001) were positively associated with CHA2DS2-VASc score, whereas P-wave amplitude (RHO=-0.141, p=0.02), P-wave voltage in lead I (RHO=-0.191, p=0.002), and left ventricle ejection fraction (RHO=-0.344, p<0.001) were negatively associated with the same score. The presence of the Morris index was associated with high CHA2DS2-VASc (p=0.022). Prolonged PR interval, Morris index, increased left atrium diameter, left ventricle diameter, left ventricle mass, and left ventricle indexed mass values as well as lower P-wave amplitude, P-wave voltage in lead I, and left ventricle ejection fraction values were correlated with higher CHA2DS2-VASc scores.

Predictive Value of CHA2DS2-VASc Score in Patients with Contrast-Induced Nephropathy After Primary Percutaneous Coronary Intervention for ST-Elevated Myocardial Infarction.

Contrast-induced nephropathy (CIN) is one of the well-known complications of cardiac catheterization and related with in-hospital and long-term morbidity and mortality. We aimed to evaluate if CHA2DS2-VASc score can also be used as a surrogate for CIN development and moreover the relationship between CIN development and in-hospital major adverse cardiac events (MACE) in patients presenting with STEMI and undergoing primary PCI. All patients presented with STEMI and underwent primary PCI between 2015-2019 in our center were included retrospectively. A total of 572 patients were included. Age [P = 0.032, β: 0.153, odds ratio (95% CI): 0.014-0.302], diabetes mellitus [(P = 0.023, β: 0.134, odds ratio (95% CI): 0.017-0.217], history of stroke [P = 0.034, β: 0.118, OR (95% CI): 0.017-0.436], volume of contrast medium [P = 0.042, β: 0.155, OR (95% CI): 0.109-0.462], left ventricular ejection fraction [P = 0.003, β: 0.376, OR (95% CI): 0.214-0.517], and CHA2DS2-VASc score [P = 0.001, β: 0.115, OR (95% CI): 0.054-0.177] were detected as independent risk factors associated with contrast-induced nephropathy development. The area under the curve for CHA2DS2-VASc score was 0.809 (95% CI: 0.760-0.857). A cut-off value of 2.5 for CHA2DS2-VASc score was associated with 80.1% sensitivity and 71.4% specificity in the prediction of contrast-induced nephropathy development. Our current study showed that the CHA2DS2-VASc risk score has an effective discriminating power in determining the contrast-induced nephropathy development and a score ≥2 defines the group at risk in patients presenting with ST-elevation myocardial infarction and underwent primary percutaneous coronary intervention. Moreover, contrast-induced nephropathy development is associated with longer coronary care unit stay and major adverse cardiac events (in-hospital decompensated heart failure, cardiogenic shock, cardiac arrest, and mortality).

Right Atrial Fluorodeoxyglucose Uptake Is a Risk Factor for Stroke and Improves Prediction of Stroke Above the CHA2DS2-VASc Score in Patients With Atrial Fibrillation.

BackgroundAtrial fibrillation (AF) is a common arrhythmia, and its most severe and dreaded complication is stroke. The CHA2DS2-VASc score is currently recommended for stroke risk assessment in AF. We aimed to explore the relationship between atrial FDG uptake and stroke and whether atrial FDG uptake could provide incremental value above the CHA2DS2-VAS score to predict stroke in AF by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT).Materials and MethodsFrom September 2017 to December 2020, we retrospectively enrolled 230 patients (115 with AF and 115 without AF as the non-AF group, matched for the date of PET/CT examination and the basic characteristics of the patient) who underwent 18F-FDG PET/CT due to tumor screening or preoperative staging after prolonged fasting and followed up for at least 12 months from the date of PET/CT examination; the endpoint event is the occurrence of stroke. We visually and quantitatively analyzed 18F-FDG uptake in the right and left atria (RA/LA), right and left atrial appendage (RAA/LAA), right and left ventricle (RV/LV), and collected clinical features. In addition, according to the endpoint event (stroke), the enrolled population was divided into the stroke group and non-stroke group, and relevant clinical features and atrial FDG uptake indicators of the two groups were analyzed. Univariate and multivariate Cox regression analyzes were used to analyze the risk factors of stroke events. The Kaplan–Meier survival curve of atrial FDG uptake was drawn, and the log-rank method was used to compare the differences in the survival curves of the two groups. Receiver operating characteristic (ROC) curves were used to examine the discriminatory power of atrial FDG uptake in predicting stroke and determine whether the addition of atrial FDG uptake improves predictive value beyond the CHA2DS2-VASc score for stroke.ResultsIn the AF group, more than half of patients had RA FDG uptake and one-fifth had LA FDG uptake, while one patient had RA FDG uptake and two patients had LA FDG uptake in the non-AF group. In quantitative analysis, the maximum standardized uptake value (SUVmax) of the RA and LA in the AF group was significantly higher than that of the non-AF group (all P < 0.001). We followed up the patients for 28 ± 10 months, and finally, 31 patients had stroke. In the stroke group, atrial fibrillation, RA SUVmax, RAA SUVmax, LAA SUVmax, age ≥ 75 years, and left atrial dilation were significantly higher than those of the non-stroke group (all P < 0.05). Multivariate Cox regression analysis showed that high RA SUVmax (RA SUVmax ≥ 2.62) was an independent risk factor for stroke (HR = 4.264, 95% CI 1.368–13.293, P = 0.012). By using the log-rank test, patients with high RA SUVmax had a significantly higher incidence of stroke compared with patients with low RA SUVmax (P < 0.001). Addition of high RA SUVmax to the CHA2DS2-VASc score could predict stroke more effectively, with a larger AUC 0.790 (P < 0.001).ConclusionThis study found a significant correlation between atrial FDG uptake and AF, especially in RA. Meanwhile, RA FDG uptake is an independent risk factor for stroke, and patients with high RA SUVmax have a significantly higher risk of stroke. Moreover, RA FDG uptake improves prediction of stroke above the CHA2DS2-VASc score in patients with AF.

Two Statistical Methods to Analyze the Role of CHA2DS2VASc Score in Patients with STEMI

The CHA2DS2VASc score includes risk factors for coronary artery disease. The aim of this study is to show that the CHA2DS2VASc score calculated at the time of hospital admission may predict mortality and major adverse cardiovascular and cerebrovascular events (MACCE) in-hospital and at 30-day follow-up for patients with STEMI, who were subjected to primary percutaneous coronary intervention (p-PCI). A retrospective cohort study was performed at University Hospital Center ‘Mother Teresa’, in the Cardiology Department between June 2021 and September 2021. The CHA2DS2VASc score was calculated at the time of hospital admission for all of them. The study population was divided into 3 groups according to the CHA2DS2VASc score at the time of admission. A statistical control of result of hospital MACCE was done. As the result of multivariable analysis, smoking and CHA2DS2VASc groups were found to be independent MACCE predictors. The chances of developing MACCE were approximately 5 times higher in a patient of the third CHA2DS2VASc group, compared to that of the first group. CHA2DS2VASc groups are important to define the likelihood that MACCE will occur in patients with ascending STEMI who had undergone PCI. The ROC plot provided a visual representation of the accuracy of CHA2DS2VASc in predicting reinfarction and stroke. AUC 0.852 (95% C.I: 0.776-0.928) showed when CHA2DS2VASc has this predictive ability for morbidity and mortality. CHA2DS2VASc ≥ 4 can be used to determine risk of reinfarction and stroke.

Evaluation of Dependence between Left Atrial Appendage Flow Velocity Examined in Transoesophageal Echocardiography (TTE) and CHA2DS2-Vasc Score in Patients with Atrial Fibrillation (AF)

Evaluation of Dependence between Left Atrial Appendage Flow Velocity Examined in Transoesophageal Echocardiography (TTE) and CHA2DS2-Vasc Score in Patients with Atrial Fibrillation (AF)

The Relationship Between Vitamin D Deficiency And CHA₂DS₂-VASc Score in Chronic Coronary Syndrome

Objective: To assess the relationship between Vitamin D level and CHA2DS2-VASc score in patients with chronic coronary syndrome (CCS). Methods:A total of 147 participants with CCS who underwent coronary angiography and had critical coronary artery stenosis were retrospectively enrolled in the study. Patients’ CHA2DS2-VASc scores were measured. Laboratory parameters including vitamin D and echocardiographic findings were recorded. Participants were divided into two groups according to CHA2DS2-VASc score, CHA2DS2-VASc score <3 as low-moderate group and CHA2DS2-VASc score ≥3 as high group. Results: Mean age was 62.7±10.5 and 80 (54.4%) were female. Age was older in the group with high CHA2DS2-VASc score (63.6±10.7 vs 56.6±6.3, p<0.001). Body mass index (BMI) and diabetes mellitus (DM) frequency were higher in the high score group (p=0.003 and p<0.001, respectively), whilst ejection fraction and vitamin D level were lower (p=0.02 and p<0.001, respectively). In multivariate logistic regression analysis with forward selection, BMI (OR: 1.383, 95% CI: 1.155-1.657, p<0.001) and Vitamin D level (OR: 0.852, 95% CI: 0.776-0.935, p=0.001) were independently associated with high CHA2DS2-VASc score. A cut-off value of 23.6 ng/ml for vitamin D level predicted high CHA2DS2-VASc score, with 61% sensitivity and 84% specificity [AUC:0.755 (0.678-0.822), %95 CI, p<0.001] in receiver operating characteristic (ROC) curve analysis. Conclusion: In patients with CCS undergoing coronary angiography, it was determined an independent relationship between low vitamin D levels and high CHA2DS2-VASc score.

The CHA2DS2-VASc risk score predicts successful endovascular treatment in patients with acute ischemic stroke.

Acute ischemic stroke is a common cause of mortality and morbidity worldwide. Percutaneous endovascular intervention is an important treatment method in ischemic stroke. Endovascular procedure success is associated with the clinical outcome of the patients. The CHA2DS2-VASC score is an important score used to determine the risk of ischemic stroke in patients with atrial fibrillation. In our study, we aimed to evaluate the relationship between procedure success and CHA2DS2-VASC score in patients with acute ischemic stroke who underwent endovascular intervention. A total of 102 consecutive patients who underwent endovascular intervention with acute ischemic stroke were included in the study. The admission CHA2DS2-VASc scores of the patients were recorded. After the procedure, the relationship between the TICI score and the CHA2DS2-VASc score was evaluated. CHA2DS2-VASc score was significantly higher in the group that resulted in unsuccessful endovascular intervention (2.78±1.44, 5.02±1.77 p<.001). Receiver-operating characteristics analysis revealed the cutoff value of CHA2DS2-VASc score ≥3 as a predictor of unsuccessful intervention with 76,6% sensitivity and 83,3% specificity, positive predictive value 50%, negative predictive value 84,6% (area under the curve [AUC]: 0.827,95% CI: 0.739-0.895, p<.001). In the multivariate analysis; atrial fibrillation ([β]=4.201; [CI]: 1.251-14.103, p=.020), CHA2DS2-VASc score ([β]=0.053; [CI]: 0.004-0.750, p=.030) were found independent predictors for unsuccessful intervention treatment. In our study, we showed that the CHA2DS2-VASc score is associated with the success of endovascular intervention in patients with acute ischemic stroke who underwent percutaneous endovascular treatment.

CHADS2 and CHA2DS2-VASc Scores Can Guide the Evaluation of Cryptogenic Ischemic Stroke.

Cryptogenic ischemic strokes (CIS) are treated with antiplatelets for stroke prevention in routine clinical practice. The objective of this study was to investigate whether the CHADS2 and CHA2DS2-VASc scores may be used to identify the patients with CIS at higher risk of ischemic stroke despite antiplatelet therapy. We calculated CHADS2 and CHA2DS2-VASc scores in patients with first ever CIS; those previously managed with antiplatelets (AP group) and in those without antiplatelets (non-AP group), using the prospectively recorded data of the Istanbul Medical School Stroke Registry from 1996-2014. Of the 4466 IS patients, 886 patients with first ever IS had complete data for score calculation. Seventy-five (39 women) of them were diagnosed with CIS. CHADS2 and CHA2DS2-VASc scores were significantly higher in the AP group of 19 patients in comparison to the non-AP group of 56 patients (P = 0.005 and P = 0.009, respectively). ROC curve analyses showed an area under curve (AUC) of 0.705 (CI: 0.57-0.84; P = 0.008) for CHADS2 score ≥3 and AUC of 0.699 (CI: 0.57-0.82; P = 0.01) for CHA2DS2-VASc score ≥4. Vascular diseases were more frequent in the AP group and these patients were older than the patients in the non-AP group (P = 0.025, P = 0.024; respectively). CHA2DS2-VASc score ≥ 4 and CHADS2 score ≥3 may be used as a predictor of the occurrence of IS despite regular antiplatelet use and suggest an embolic source which will respond better to anticogulation. Our results support that CHADS2 and CHA2DS2-VASc scores may be useful to identify subgroups among patients with CIS for individualizing diagnostic approach, planning future workup and preventive treatment.

CHA2DS2-VASc score in patients with COVID-19 pneumonia and its relationship with biomarkers of thrombosis, inflammation and myocardial injury.

CHA2DS2-VASC score associates with worse prognosis in coronavirus-disease-19 (COVID-19). This study investigated laboratory correlates of increasing CHA2DS2- VASc in patients with COVID-19. Patients with COVID-19 were stratified by CHA2DS2-VASc (Group 1: CHA2DS2-VASc 0-1; Group 2: CHA2DS2-VASc 2-3; Group 3: CHA2DS2-VASc ≥4). We found stepwise increase of D-dimer, hs-Troponin and in-hospital mortality across groups (all P < 0.01). D-dimer and hs-Troponin remained independently associated with CHA2DS2-VASc (B = 0.145, P = 0.03; B = 0.320, P < 0.001, respectively). We found significant correlations between D-dimer and C-reactive protein (CRP) in Group 1 and 2, not in Group 3 (r2 = 0.103, P = 0.005; r2 = 0.226, P = 0.001; r2 = 0.021, P = 0.253 respectively), and between D-dimer and hs-Troponin in group 2 and 3, not in Group 1 (r2 = 0.122, P = 0.003; r2 = 0.120, P = 0.007; r2 = 0.006, P = 0.514 respectively). In our cohort, CHA2DS2- VASc was independently associated with D-dimer and hs- Troponin increase. Variable relationships of D-dimer with hs-Troponin and CRP within different CHA2DS2-VASc strata suggest multiple mechanisms to be responsible for D-dimer increase in COVID-19.

Acute Dental Periapical Abscess and New-Onset Atrial Fibrillation: A Nationwide, Population-Based Cohort Study.

There are limited data on the relationship of acute dental infections with hospitalisation and new-onset atrial fibrillation (AF). This study aimed to assess the relationship between acute periapical abscess and incident AF. This was a retrospective cohort study from a French national database of patients hospitalized in 2013 (3.4 million patients) with at least five years of follow up. In total, 3,056,291 adults (55.1% female) required hospital admission in French hospitals in 2013 while not having a history of AF. Of 4693 patients classified as having dental periapical abscess, 435 (9.27%) developed AF, compared to 326,241 (10.69%) without dental periapical abscess that developed AF over a mean follow-up of 4.8 ± 1.7 years. Multivariable analysis indicated that dental periapical abscess acted as an independent predictor for new onset AF (p < 0.01). The CHA2DS2VASc score in patients with acute dental periapical abscess had moderate predictive value for development of AF, with Area Under the Curve (AUC) 0.73 (95% CI, 0.71–0.76). An increased risk of new onset AF was identified for individuals hospitalized with dental periapical abscess. Careful follow up of patients with severe, acute dental periapical infections is needed for incident AF, as well as investigations of possible mechanisms linking these conditions.

MO483CHA2DS2-VASC SCORE IN PATIENTS WITH EGFR&lt;30 ML/MIN/1.73 M2 AND ATRIAL FIBRILLATION*

Abstract Background and Aims CHA2DS2-VASc score (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65-74 years, female sex) is a validated tool for evaluation of risk of stroke and systemic emboli in patients with atrial fibrillation without nephropathy. The validity of risk determination based on the CHA2DS2-VASc score in patients with severe nephropathy is untested. We investigate the validity of the CHA2DS2-VASc score in patients with eGFR&amp;lt;30 ml/min/1.73m2 (including dialysis treated patients) and atrial fibrillation without anticoagulation treatment. Method In a retrospective cohort study, all patients with atrial fibrillation and eGFR&amp;lt;30 ml/min/1.73 m2 were identified in nationwide Danish registers between 2008 and 2018 with subsequent exclusion of patients initiating anticoagulation treatment based on redeemed prescriptions. Cumulative incidences of stroke stratified on CHA2DS2-VASc score were computed using the Aalen-Johansen estimator, and one-year risk of stroke was calculated with comparison of CHA2DS2-VASc score based on Cox regression models adjusted for age, sex and dialysis status with G-computation of one-year risk standardized to the distribution of risk factors in the sample. Results From 2,452 patients with eGFR &amp;lt;30 ml/min/1.73 m2 and de novo atrial fibrillation, a total of 1,575 patients (64.2%) without anticoagulation treatment were included. Mean age was 78.0 years (standard deviation ±12.2), 53.3% were male, and 25.5% were on dialysis. The distribution of patients into CHA2DS2-VASc score categories of 0-1, 2, 3, 4 and ≥5 was 8.7%, 14.5%, 24.6%, 24.7% and 27.5%, respectively. Cumulative incidence of stroke in non-dialysis dependent and dialysis-dependent patients are shown in the figure. Overall, standardized one-year risk of stroke was 3.3% (95%CI 1.3-6.4%), 2.5% (95%CI 1.0-4.1%), 5.9% (95%CI 3.9-8.2%), 5.1% (95%CI 3.6-7.0%), and 7.3% (95%CI 5.2-10.2%) for CHA2DS2-VASc score categories of 0-1, 2, 3, 4 and ≥5, respectively. Comparably, standardized one-year risk of stroke was 2.5% (95%CI 0.3-5.7%), 1.9% (95%CI 0.0-4.7%), 7.4% (95%CI 3.2-11.5%), 4.7% (95%CI 1.0-8.3%), and 16.5% (95%CI 7.9-27.2%) for CHA2DS2-VASc score categories of 0-1, 2, 3, 4 and ≥5, respectively, in dialysis-treated patients, and 4.3% (95%CI 1.0-10.3%), 2.9% (95%CI 1.1-4.9%), 5.5% (95%CI 3.5-8.1%), 5.1% (95%CI 3.4-7.1%), and 5.9% (95%CI 3.8-8.5%) for CHA2DS2-VASc score categories of 0-1, 2, 3, 4 and ≥5, respectively, in non-dialysis-dependent patients. Conclusion Overall, CHA2DS2-VASc score was associated with a progressive increase in one-year risk of stroke. Although the association was most obvious in non-dialysis dependent patients, discrepancy was evident with regard to risk in patients with CHA2DS2-VASc score ≤1 in both subgroups, albeit less so in adjusted analyses.

The culprit of cryptogenic stroke: the short-term versus long-term atrial fibrillation detection rate in a tertiary care centre

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Limburg Clinical Research Center OnBehalf Mobile Health Unit &amp; Future Health Background Cryptogenic stroke (CS) and transient ischemic attack (TIA) patients have no determined aetiology at discharge. A possible cause for stroke is atrial fibrillation (AF). AF occurs in 20%-40% of the CS patients and diagnosis is highly dependent on monitoring duration. A long-term monitoring method is the insertable loop recorder (ILR), recommended by the European Society of Cardiology. However, this is not routinely used in Belgium despite reimbursement. Purpose This study aims to determine the AF detection rates of different methods used in clinical practice, ranging from short-term monitoring (monitoring in a stroke unit, 12-lead electrocardiogram (ECG), and 24-hour ECG), seven-day Holter, and long-term monitoring (smartphone application and ILR). Methods A monocentric, retrospective study was conducted in adults with CS or TIA between 1/01/17 - 1/01/20. Data were collected from the electronic medical record. The primary endpoint was the detection rate and time until first AF detection. Results A total of 368 patients suffered from a CS or TIA. Most of them were monitored in the stroke unit (96%) or with a 12-lead ECG (93%). A 24-hour ECG was used in 26%, a seven-day Holter in 38%. For long-term monitoring, a smartphone application was used in 3%. ILRs were inserted in 6%, with a median time of 102 days after stroke (IQR: 48-321). One year after ILR insertion, AF was detected in 23%. AF detection increased with monitoring duration, as shown in the figure, except for 24-hour ECG, which detected no AF. Therefore, the AF detection rate was different between short-term monitoring (5%) and seven-day Holter (10%; p=.034), and short- and long-term monitoring (16%; p=.01). The age of CS patients without AF (Mdn = 71yr) was lower than those with AF (Mdn = 79yr; p=.001). The National Institutes of Health Stroke Scale (NIHSS) and the CHA2DS2-VASc score of patients without AF (Mdn = 3) was lower than those with AF (Mdn = 6, p&amp;lt;.001; Mdn = 4, p=.004 respectively). The one-year mortality of patients with AF was 15% compared to 8% for patients without AF. No patients with an ILR deceased within one year after the stroke. Conclusions Detection of AF was associated with higher age, NIHSS, and CHA2DS2-VASc scores. These variables can be used to select patients for the insertion of ILRs. The detection rate of AF was significantly higher with long-term monitoring and seven-day Holter compared to short-term monitoring. However, only 38% of the patients were monitored for a week, and only 6% had an ILR inserted. Therefore, despite guideline recommendations, long-term cardiac monitoring is underutilised in this population of CS patients. Nevertheless, AF was still detected in 14% of CS patients within one year after the stroke. These findings emphasise the need for more monitoring with a seven-day Holter, smartphone app, and ILR in this patient population. Consequently, this will result in more accurate treatment of AF as secondary prevention of CS. Abstract Figure. Time to first AF detection after stroke

Correlation between CHA2DS2-VASc score and left atrium size in non-valvular atrial fibrillation

The CHA2DS2-VASc score is validated to evaluate the risk of thromboembolism in non-valvular atrial fibrillation (AF). The relationship between the predictive value of thromboembolic risk by echocardiographic parameters and CHA2DS2-VASc score is still misunderstood. The aim of this study was to search a relationship between echocardiographic parameters and CHA2DS2-Vasc score in patients with non-valvular AF. One hundred and twenty-two patients were hospitalized for AF. The CHA2DS2-VASc score was evaluated and echocardiography with assessment of the left atrium (surface diameter and volume) was performed. Regular monitoring was provided during 8 ± 12 months. The mean age of our patients was 60 ± 15 years, 66% ( n = 71) men and 34% ( n = 36) women. AF was classified as paroxysmal (59%), as persistent (18%), and as permanent (28%). AF was idiopathic in 34% of cases and associated with hypertensive heart disease in 26%. The percentage of patients who had a CHA2DS2-VASc score 0, 1, and ≥ 2 was 21%, 24% and 55%. Sixty-six percent of patients have been treated with anticoagulant, 30% were put on aspirin and 4% abstaining. During follow-up, nine patients were hospitalized for heart failure, 6 patients (5%) had stroke, 4 patients (4%) had a non-major bleeding and one patient died. No correlation was found between CHA2DS2-VASc score and the left atrium dimensions ( P = 0.6, 0.2, 0.8 respectively for the diameter, surface area and volume of left atrium). Left atrial dimensions are not correlated to CHA2DS2-VASc score. Other techniques could possibly be more sensitive such as the atrial strain.

Prognostic Value of the CHA2DS2-VASc Score after Endovascular Therapy for Femoral Popliteal Artery Lesions.

Aim: Originally developed for predicting the risk of stroke in patients with atrial fibrillation (AF), the CHA 2 DS 2 -VASc score also has the potential to predict the risk of other cardiovascular disease. This study aimed to investigate the prognostic value of the CHA 2 DS 2 -VASc score in patients with peripheral artery disease (PAD) requiring Femoral popliteal (FP) endovascular therapy (EVT). Methods: This multicenter, retrospective study analyzed the clinical database of 2190 patients who underwent FP EVT for symptomatic PAD (Rutherford categories 2–4) between January 2010 and December 2018. We calculated the CHA 2 DS 2 -VASc score and then investigated the association between the score, as well as AF, and their prognosis. Outcome measures were major adverse cardiovascular events (MACEs) and major adverse limb events (MALEs). Results: During a median follow-up of 3.0 years (interquartile range, 1.5–5.0 years), 532 MACEs and 562 MALEs occurred. The CHA 2 DS 2 -VASc score and AF were independently associated with an increased risk of MACEs; their adjusted hazard ratios [95% confidence intervals] were 1.28 [1.20–1.36] ( P ＜0.001) per 1-point increase and 1.49 [1.06–2.09] ( P =0.022), respectively. The CHA 2 DS 2 -VASc score was almost linearly associated with MACEs, without any clear threshold point. On the other hand, these variables were not associated with MALEs risk ( P =0.32 and 0.48). Conclusion: The CHA 2 DS 2 -VASc score and AF were independently associated with the increased risk of MACEs but not of MALEs in patients with symptomatic PAD who underwent FP EVT. The score might be useful in stratifying the MACEs risk in this type of patients.

The relationship of the serum endocan level with the CHA2DS2-VASc score in patients with paroxysmal atrial fibrillation

BackgroundIn this study considering the relationship between serum endocan and CHA2DS2-VASc score, we assumed that endocan level could be a new biomarker for stroke risk in patients with paroxysmal atrial fibrillation (PAF). It was examined that endocan could be an alternative to determine the risk of stroke and anticoagulation strategy in patients with PAF. The CHA2DS2-VASc scores were calculated for 192 patients with PAF, and their serum endocan levels were measured. The patients were divided into two groups as those with low to moderate (0-1) and those with high (≥ 2) CHA2DS2-VASc scores, and the endocan levels were compared between these two groups.ResultsThe serum endocan level was significantly higher in the high CHA2DS2-VASc score group (p < 0.001). In the multivariate logistic regression analysis, endocan, C-reactive protein, and low-density lipoprotein were found to be independent determinants of the CHA2DS2-VASc score. The predictive value of endocan was analyzed using the ROC curve analysis, which revealed that endocan predicted a high stroke risk (CHA2DS2-VASc ≥ 2) at 82.5% sensitivity and 71.2% specificity at the cutoff value of 1.342.ConclusionThis study indicates that endocan is significantly associated with CHA2DS2-VASc score. We demonstrated that endocan could be a new biomarker for the prediction of a high stroke risk among patients diagnosed with PAF.