Fabienne Steiner1,2, Pascal B Meyre1,2, Stefanie Aeschbacher1,2, Michael Coslovsky1,2,3, Tim Sinnecker4,5, Manuel R Blum6,7, Nicolas Rodondi6,7, Carlo W Cereda8, Marcello di Valentino9, Florence Wenger1,2, Andrea Cussigh1,2, Philipp Krisai1,2, Laurent Roten10, Tobias Reichlin10, David Conen1,11, Stefan Osswald1,2, Leo H Bonati5, Michael Kühne1,2. 1. Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland. 2. Department of Cardiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland. 3. Clinical Trial Unit Basel, Department of Clinical Research, University Hospital Basel, Basel, Switzerland. 4. Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering, University of Basel, Basel, Switzerland. 5. Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland. 6. Institute of Primary Health Care (BIHAM, Berner Institut für Hausarztmedizin), University of Bern, Bern, Switzerland. 7. Department of General Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. 8. Neurocenter of Southern Switzerland, Neurology, Ospedale Regionale di Lugano, Lugano, Switzerland. 9. Department of Cardiology, Ospedale San Giovanni, Bellinzona, Switzerland. 10. Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. 11. Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
Abstract
Background: Silent and overt ischemic brain lesions are common and associated with adverse outcome. Whether the CHA2DS2-VASc score and its components predict magnetic resonance imaging (MRI)-detected ischemic silent and overt brain lesions in patients with atrial fibrillation (AF) is unclear. Methods: In this cross-sectional analysis, patients with AF were enrolled in a multicenter cohort study in Switzerland. Outcomes were clinically overt, silent [in the absence of a history of stroke/transient ischemic attack (TIA)] and any MRI-detected ischemic brain lesions. Logistic regression analyses were performed to assess the relationship of the CHA2DS2-VASc score and its components with ischemic brain lesions. An adapted CHA2D-VASc score (excluding history of stroke/TIA) for the analyses of clinically overt and silent ischemic brain lesions was used. Results: Overall, 1,741 patients were included in the analysis (age 73 ± 8 years, 27.4% female). At least one ischemic brain lesion was observed in 36.8% (clinically overt: 10.5%; silent: 22.9%; transient ischemic attack: 3.4%). The CHA2D-VASc score was strongly associated with clinically overt and silent ischemic brain lesions {odds ratio (OR) [95% confidence interval (CI)] 1.32 (1.17-1.49), p < 0.001 and 1.20 (1.10-1.30), p < 0.001, respectively}. Age 65-74 years (OR 2.58; 95%CI 1.29-5.90; p = 0.013), age ≥75 years (4.13; 2.07-9.43; p < 0.001), hypertension (1.90; 1.28-2.88; p = 0.002) and diabetes (1.48; 1.00-2.18; p = 0.047) were associated with clinically overt brain lesions, whereas age 65-74 years (1.95; 1.26-3.10; p = 0.004), age ≥75 years (3.06; 1.98-4.89; p < 0.001) and vascular disease (1.39; 1.07-1.79; p = 0.012) were associated with silent ischemic brain lesions. Conclusions: A higher CHA2D-VASc score was associated with a higher risk of both overt and silent ischemic brain lesions. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02105844.
Background: Silent and overt ischemic brain lesions are common and associated with adverse outcome. Whether the CHA2DS2-VASc score and its components predict magnetic resonance imaging (MRI)-detected ischemic silent and overt brain lesions in patients with atrial fibrillation (AF) is unclear. Methods: In this cross-sectional analysis, patients with AF were enrolled in a multicenter cohort study in Switzerland. Outcomes were clinically overt, silent [in the absence of a history of stroke/transient ischemic attack (TIA)] and any MRI-detected ischemic brain lesions. Logistic regression analyses were performed to assess the relationship of the CHA2DS2-VASc score and its components with ischemic brain lesions. An adapted CHA2D-VASc score (excluding history of stroke/TIA) for the analyses of clinically overt and silent ischemic brain lesions was used. Results: Overall, 1,741 patients were included in the analysis (age 73 ± 8 years, 27.4% female). At least one ischemic brain lesion was observed in 36.8% (clinically overt: 10.5%; silent: 22.9%; transient ischemic attack: 3.4%). The CHA2D-VASc score was strongly associated with clinically overt and silent ischemic brain lesions {odds ratio (OR) [95% confidence interval (CI)] 1.32 (1.17-1.49), p < 0.001 and 1.20 (1.10-1.30), p < 0.001, respectively}. Age 65-74 years (OR 2.58; 95%CI 1.29-5.90; p = 0.013), age ≥75 years (4.13; 2.07-9.43; p < 0.001), hypertension (1.90; 1.28-2.88; p = 0.002) and diabetes (1.48; 1.00-2.18; p = 0.047) were associated with clinically overt brain lesions, whereas age 65-74 years (1.95; 1.26-3.10; p = 0.004), age ≥75 years (3.06; 1.98-4.89; p < 0.001) and vascular disease (1.39; 1.07-1.79; p = 0.012) were associated with silent ischemic brain lesions. Conclusions: A higher CHA2D-VASc score was associated with a higher risk of both overt and silent ischemic brain lesions. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02105844.
Authors: A John Camm; Paulus Kirchhof; Gregory Y H Lip; Ulrich Schotten; Irene Savelieva; Sabine Ernst; Isabelle C Van Gelder; Nawwar Al-Attar; Gerhard Hindricks; Bernard Prendergast; Hein Heidbuchel; Ottavio Alfieri; Annalisa Angelini; Dan Atar; Paolo Colonna; Raffaele De Caterina; Johan De Sutter; Andreas Goette; Bulent Gorenek; Magnus Heldal; Stefan H Hohloser; Philippe Kolh; Jean-Yves Le Heuzey; Piotr Ponikowski; Frans H Rutten Journal: Europace Date: 2010-10 Impact factor: 5.214
Authors: Thomas J Wang; Martin G Larson; Daniel Levy; Ramachandran S Vasan; Eric P Leip; Philip A Wolf; Ralph B D'Agostino; Joanne M Murabito; William B Kannel; Emelia J Benjamin Journal: Circulation Date: 2003-05-27 Impact factor: 29.690
Authors: Ziad Hijazi; Johan Lindbäck; John H Alexander; Michael Hanna; Claes Held; Elaine M Hylek; Renato D Lopes; Jonas Oldgren; Agneta Siegbahn; Ralph A H Stewart; Harvey D White; Christopher B Granger; Lars Wallentin Journal: Eur Heart J Date: 2016-02-25 Impact factor: 29.983
Authors: Mandeep R Mehra; Muthiah Vaduganathan; Min Fu; João Pedro Ferreira; Stefan D Anker; John G F Cleland; Carolyn S P Lam; Dirk J van Veldhuisen; William M Byra; Theodore E Spiro; Hsiaowei Deng; Faiez Zannad; Barry Greenberg Journal: Eur Heart J Date: 2019-11-21 Impact factor: 29.983