Yap-Hang Chan1, Kai-Hang Yiu2, Kui-Kai Lau3, Yuen-Fung Yiu2, Sheung-Wai Li4, Tai-Hing Lam5, Chu-Pak Lau2, Chung-Wah Siu6, Hung-Fat Tse7. 1. Division of Cardiology, Queen Mary Hospital, The University of Hong Kong, China; School of Public Health, The University of Hong Kong, China. 2. Division of Cardiology, Queen Mary Hospital, The University of Hong Kong, China. 3. Division of Neurology, Queen Mary Hospital, The University of Hong Kong, China. 4. Department of Medicine, Tung Wah Hospital, China. 5. School of Public Health, The University of Hong Kong, China. 6. Division of Cardiology, Queen Mary Hospital, The University of Hong Kong, China; Research Center of Heart, Brain, Hormone and Healthy Ageing, University of Hong Kong, China. 7. Division of Cardiology, Queen Mary Hospital, The University of Hong Kong, China; Research Center of Heart, Brain, Hormone and Healthy Ageing, University of Hong Kong, China. Electronic address: hftse@hkucc.hku.hk.
Abstract
OBJECTIVES: To investigate whether the CHADS2 and CHA2DS2-VASc scores have clinical utility for prediction of adverse vascular function and vascular dysfunction-mediated incident cardiovascular (CV) events among high-risk patients without atrial fibrillation (AF), and the additional value of incorporating PR prolongation to the scores. METHODS: We analyzed 579 high-risk CV outpatients without clinical AF in a prospective cohort for new-onset ischemic stroke, myocardial infarction (MI), congestive heart failure (CHF), and CV death. Brachial flow-mediated dilation (FMD) and nitroglycerin-mediated dilatation (NMD), carotid intima-media thickness (IMT) and pulse wave velocity (PWV) were determined. RESULTS: Baseline CHADS2 score was associated with lower FMD (Pearson r = -0.16, P < 0.001) and NMD (r = -0.17, P < 0.001), higher carotid IMT (r = 0.30, P < 0.001) and PWV (r = 0.35, P < 0.001; similar for CHA2DS2-VASc score: All P < 0.05). After follow-up of 63 ± 11 months, 82 patients (14.2%) developed combined CV endpoint. ROC curve analysis showed that both CHADS2 and CHA2DS2-VASc scores were predictors for ischemic stroke (C-Statistic: CHADS2 0.70, P = 0.004; CHA2DS2-VASc 0.68, P = 0.010), MI (CHADS2 0.63, P = 0.030; CHA2DS2-VASc 0.70, P = 0.001), and CV death (CHADS2 0.63, P = 0.022; CHA2DS2-VASc 0.65, P = 0.011). Higher CHADS2 score was associated with reduced event-free survival from combined CV endpoints (log-rank = 16.7, P < 0.001) with differences potentiated if stratified by CHA2DS2-VASc score (log-rank = 29.2, P < 0.001). Incorporating PR prolongation, the CHA2DS2-VASc-PR score achieved the highest C-Statistic for CV death prediction (0.70, P < 0.001) superior to the CHADS2 score (chi-square: 12.1, P = 0.0005). CONCLUSIONS: The CHADS2 and CHA2DS2-VASc predict vascular dysfunction and cardiovascular events in high-risk CV patients without clinical AF, with further improved performance incorporating PR prolongation.
OBJECTIVES: To investigate whether the CHADS2 and CHA2DS2-VASc scores have clinical utility for prediction of adverse vascular function and vascular dysfunction-mediated incident cardiovascular (CV) events among high-risk patients without atrial fibrillation (AF), and the additional value of incorporating PR prolongation to the scores. METHODS: We analyzed 579 high-risk CV outpatients without clinical AF in a prospective cohort for new-onset ischemic stroke, myocardial infarction (MI), congestive heart failure (CHF), and CV death. Brachial flow-mediated dilation (FMD) and nitroglycerin-mediated dilatation (NMD), carotid intima-media thickness (IMT) and pulse wave velocity (PWV) were determined. RESULTS: Baseline CHADS2 score was associated with lower FMD (Pearson r = -0.16, P < 0.001) and NMD (r = -0.17, P < 0.001), higher carotid IMT (r = 0.30, P < 0.001) and PWV (r = 0.35, P < 0.001; similar for CHA2DS2-VASc score: All P < 0.05). After follow-up of 63 ± 11 months, 82 patients (14.2%) developed combined CV endpoint. ROC curve analysis showed that both CHADS2 and CHA2DS2-VASc scores were predictors for ischemic stroke (C-Statistic: CHADS2 0.70, P = 0.004; CHA2DS2-VASc 0.68, P = 0.010), MI (CHADS2 0.63, P = 0.030; CHA2DS2-VASc 0.70, P = 0.001), and CV death (CHADS2 0.63, P = 0.022; CHA2DS2-VASc 0.65, P = 0.011). Higher CHADS2 score was associated with reduced event-free survival from combined CV endpoints (log-rank = 16.7, P < 0.001) with differences potentiated if stratified by CHA2DS2-VASc score (log-rank = 29.2, P < 0.001). Incorporating PR prolongation, the CHA2DS2-VASc-PR score achieved the highest C-Statistic for CV death prediction (0.70, P < 0.001) superior to the CHADS2 score (chi-square: 12.1, P = 0.0005). CONCLUSIONS: The CHADS2 and CHA2DS2-VASc predict vascular dysfunction and cardiovascular events in high-risk CV patients without clinical AF, with further improved performance incorporating PR prolongation.
Authors: Sweta Tiwari; Maja-Lisa Løchen; Bjarne K Jacobsen; Laila A Hopstock; Audhild Nyrnes; Inger Njølstad; Ellisiv B Mathiesen; Henrik Schirmer Journal: Open Heart Date: 2016-09-06