Pooja S Jagadish1, Rajesh Kabra2. 1. Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA. 2. Division of Cardiology, Department of Internal Medicine, Division of Cardiology, University of Tennessee Health Science Center, 1211 Union Avenue, Suite 965, Memphis, TN, 38163, USA. rkabra@uthsc.edu.
Abstract
PURPOSE OF REVIEW: Stroke prevention is the cornerstone of atrial fibrillation (AF) management and the anticoagulation decision is currently based on CHA2DS2-VASc risk score. We discuss several novel risk factors besides those included in CHA2DS2-VASc score and alternative models for stroke prediction. RECENT FINDINGS: Several clinical markers including obstructive sleep apnea and renal failure, laboratory markers like brain natriuretic peptide, imaging criteria including left atrial appendage morphology, spontaneous echo contrast, and coronary artery calcium score may predict stroke in AF patients. Addition of African American ethnicity to CHA2DS2-VASc score also improves stroke prediction in AF. Finally, novel models including TIMI-AF score, ATRIA score, and GARFIELD-AF scores have potential roles in risk stratification for stroke. While CHA2DS2-VASc score is the currently recommended risk stratification model for stroke prediction in AF, use of additional clinical, laboratory, imaging markers, ethnicity, and novel stroke prediction models may further assist in decision to anticoagulate the AF patient for stroke prevention.
PURPOSE OF REVIEW: Stroke prevention is the cornerstone of atrial fibrillation (AF) management and the anticoagulation decision is currently based on CHA2DS2-VASc risk score. We discuss several novel risk factors besides those included in CHA2DS2-VASc score and alternative models for stroke prediction. RECENT FINDINGS: Several clinical markers including obstructive sleep apnea and renal failure, laboratory markers like brain natriuretic peptide, imaging criteria including left atrial appendage morphology, spontaneous echo contrast, and coronary artery calcium score may predict stroke in AFpatients. Addition of African American ethnicity to CHA2DS2-VASc score also improves stroke prediction in AF. Finally, novel models including TIMI-AF score, ATRIA score, and GARFIELD-AF scores have potential roles in risk stratification for stroke. While CHA2DS2-VASc score is the currently recommended risk stratification model for stroke prediction in AF, use of additional clinical, laboratory, imaging markers, ethnicity, and novel stroke prediction models may further assist in decision to anticoagulate the AFpatient for stroke prevention.
Authors: Jonathan P Piccini; Elizabeth S Fraulo; Jack E Ansell; Gregg C Fonarow; Bernard J Gersh; Alan S Go; Elaine M Hylek; Peter R Kowey; Kenneth W Mahaffey; Laine E Thomas; Melissa H Kong; Renato D Lopes; Roger M Mills; Eric D Peterson Journal: Am Heart J Date: 2011-10 Impact factor: 4.749
Authors: H Klar Yaggi; John Concato; Walter N Kernan; Judith H Lichtman; Lawrence M Brass; Vahid Mohsenin Journal: N Engl J Med Date: 2005-11-10 Impact factor: 91.245
Authors: W D Rosamond; A R Folsom; L E Chambless; C H Wang; P G McGovern; G Howard; L S Copper; E Shahar Journal: Stroke Date: 1999-04 Impact factor: 7.914
Authors: George Howard; Mary Cushman; Brett M Kissela; Dawn O Kleindorfer; Leslie A McClure; Monika M Safford; J David Rhodes; Elsayed Z Soliman; Claudia S Moy; Suzanne E Judd; Virginia J Howard Journal: Stroke Date: 2011-09-29 Impact factor: 7.914
Authors: Apoor S Gami; Gregg Pressman; Sean M Caples; Ravi Kanagala; Joseph J Gard; Diane E Davison; Joseph F Malouf; Naser M Ammash; Paul A Friedman; Virend K Somers Journal: Circulation Date: 2004-07-12 Impact factor: 29.690
Authors: Jonas Bjerring Olesen; Gregory Y H Lip; Morten Lock Hansen; Peter Riis Hansen; Janne Schurmann Tolstrup; Jesper Lindhardsen; Christian Selmer; Ole Ahlehoff; Anne-Marie Schjerning Olsen; Gunnar Hilmar Gislason; Christian Torp-Pedersen Journal: BMJ Date: 2011-01-31