J Cardiovasc Imaging.  2018 Sep;26(3):135-143. 10.4250/jcvi.2018.26.e17.

Cardiac Structural or Functional Changes Associated with CHAâ‚‚DSâ‚‚-VASc Scores in Nonvalvular Atrial Fibrillation: A Cross-Sectional Study Using Echocardiography

• Jang AY
• Yu J
• Park YM
• Shin MS
• Chung WJ
• Moon J

• KMID: 2429854
• DOI: http://doi.org/10.4250/jcvi.2018.26.e17

Abstract

BACKGROUND
CHA2DS2-VASc is the most widely accepted scoring system for atrial fibrillation (AF) to assess stroke risk, although little has been revealed regarding the accompanying cardiac functional/structural changes. This echocardiography study was undertaken to understand the changes related to CHA2DS2-VASc scores.
METHODS
A total of 4,795 nonvalvular AF patients were enrolled for the cohort, from which 591 were excluded as they did not meet the inclusion criteria. Based on the CHA2DS2-VASc scores, the remaining 4,204 patients included in the study were divided into 4 groups: 0 to 1 (n = 991); 2 to 3 (n = 1,642); 4 to 6 (n = 1,407); 7 to 9 (n = 164).
RESULTS
Increase in the left ventricular mass index and prevalence of left ventricular hypertrophy (LVH) were observed with elevating CHA2DS2-VASc scores (p < 0.05 for all). Diastolic parameters such as left atrial volume index (LAVI) and the ratio of early diastolic mitral inflow velocity to early diastolic velocity of the mitral annulus (E/E"²) also increased significantly in the higher CHA2DS2-VASc score groups (p < 0.001 for all), although two-way ANOVA analysis showed that such incremental diastolic impairment was independent of hypertension. LVH (hazard ratio [HR], 3.609; confidence interval [CI], 2.426-5.369; p < 0.001) and E/E"² (HR, 1.087; CI, 1.054-1.121; p < 0.001) were independent risk factors for CHA2DS2-VASc scores 2 or higher.
CONCLUSIONS
Our findings suggest that increasing CHA2DS2-VASc scores are associated with impaired diastolic function that may represent high left atrial pressure favoring thrombogenic propensity.

Keyword

Atrial fibrillation; Left ventricular hypertrophy; CHAâ‚‚DSâ‚‚-VASc score; Diastolic dysfunction; Hypertension

MeSH Terms

Atrial Fibrillation*
Atrial Pressure
Cohort Studies
Cross-Sectional Studies*
Echocardiography*
Humans
Hypertension
Hypertrophy, Left Ventricular
Prevalence
Risk Factors
Stroke

Figure

• 

  Figure 1 Diagram for detalied enrollement of patients. A total of 4,795 patients were enrolled for the cohort. After excluding 591 patients with either missing data or valvular disease or surgery, 4,204 patients were allocated in each group according to their CHA2DS2 VASc scores.

• 

  Figure 2 Trends of each echocardiographic parameter. Tukey's post hoc test results for left ventricular mass index (A), left atrial dimension (B), left atrial volume index (C), and the ratio of early diastolic mitral inflow velocity to early diastolic velocity of the mitral annulus (D) are shown. E/E′: the ratio of early diastolic mitral inflow velocity to early diastolic velocity of the mitral annulus, LAD: left atrial anterior posterior dimension, LAVI: left atrial volume index, LVMI: left ventricular mass index. *p < 0.05.

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