Raphael Philippart1, Anne Brunet-Bernard1, Nicolas Clementy1, Thierry Bourguignon1, Alain Mirza1, Dominique Babuty1, Denis Angoulvant1, Gregory Y H Lip2, Laurent Fauchier3. 1. Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours 37044, France. 2. University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH, UK. 3. Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours 37044, France lfau@med.univ-tours.fr.
Abstract
AIMS: The CHA2DS2VASc score is a clinical risk stratification tool which estimates the risk of stroke and thromboembolism in non-valvular atrial fibrillation (AF). We aimed to establish the value of this score for risk evaluation in patients with non-valvular AF and valvular heart disease. METHODS AND RESULTS: Among 8053 patients with non-valvular AF (ESC guidelines definition), patients were categorized into Group 1 (no valve disease, n = 6851; 85%) and Group 2 (valve disease with neither rheumatic mitral stenosis nor valve prothesis, n = 1202; 15%). After follow-up of 868 ± 1043 days, 627 stroke/ thromboembolic (TE) events were recorded. Group 2 was significantly older, had a higher CHA2DS2VASc score and had a higher risk of thromboembolic events [hazard ratio (HR) 1.39; 95% CI 1.14-1.69, P = 0.001] compared with Group 1. Severe valve disease was not associated with worse prognosis for stroke/TE events. In the two groups, stroke/TE risk increased with a higher CHA2DS2VASc score. Factors independently associated with increased risk of stroke/TE events were older age (HR 1.25, 95% CI 1.14-1.36 per 10-year increase, P < 0.0001) and higher CHA2DS2VASc score (HR 1.33, 95% CI 1.23-1.45, P < 0.0001). The predictive value (c-statistic) of the CHA2DS2VASc score was similar in the two groups. CONCLUSION: In patients with non-valvular AF, left-sided valvular heart disease (excluding mitral stenosis and protheses) was associated with an increased risk of stroke/TE events. A higher CHA2DS2VASc score in these patients is likely to explain these results. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: The CHA2DS2VASc score is a clinical risk stratification tool which estimates the risk of stroke and thromboembolism in non-valvular atrial fibrillation (AF). We aimed to establish the value of this score for risk evaluation in patients with non-valvular AF and valvular heart disease. METHODS AND RESULTS: Among 8053 patients with non-valvular AF (ESC guidelines definition), patients were categorized into Group 1 (no valve disease, n = 6851; 85%) and Group 2 (valve disease with neither rheumatic mitral stenosis nor valve prothesis, n = 1202; 15%). After follow-up of 868 ± 1043 days, 627 stroke/ thromboembolic (TE) events were recorded. Group 2 was significantly older, had a higher CHA2DS2VASc score and had a higher risk of thromboembolic events [hazard ratio (HR) 1.39; 95% CI 1.14-1.69, P = 0.001] compared with Group 1. Severe valve disease was not associated with worse prognosis for stroke/TE events. In the two groups, stroke/TE risk increased with a higher CHA2DS2VASc score. Factors independently associated with increased risk of stroke/TE events were older age (HR 1.25, 95% CI 1.14-1.36 per 10-year increase, P < 0.0001) and higher CHA2DS2VASc score (HR 1.33, 95% CI 1.23-1.45, P < 0.0001). The predictive value (c-statistic) of the CHA2DS2VASc score was similar in the two groups. CONCLUSION: In patients with non-valvular AF, left-sided valvular heart disease (excluding mitral stenosis and protheses) was associated with an increased risk of stroke/TE events. A higher CHA2DS2VASc score in these patients is likely to explain these results. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Amitava Banerjee; Victoria Allan; Spiros Denaxas; Anoop Shah; Dipak Kotecha; Pier D Lambiase; Jacob Joseph; Lars H Lund; Harry Hemingway Journal: Europace Date: 2019-12-01 Impact factor: 5.214
Authors: Ashwin S Nathan; Lin Yang; Zhi Geng; Elias J Dayoub; Sameed Ahmed M Khatana; Paul N Fiorilli; Howard C Herrmann; Wilson Y Szeto; Pavan Atluri; Michael A Acker; Nimesh D Desai; David S Frankel; Francis E Marchlinski; Alexander C Fanaroff; Jay Giri; Peter W Groeneveld Journal: Am Heart J Date: 2020-10-24 Impact factor: 5.099
Authors: Mate Vamos; Jonas Oldgren; Gi-Byoung Nam; Gregory Y H Lip; Hugh Calkins; Jun Zhu; Kwo-Chang Ueng; Ulf Ludwigs; Mattias Wieloch; John Stewart; Stefan H Hohnloser Journal: Eur Heart J Cardiovasc Pharmacother Date: 2022-06-08