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http://dx.doi.org/10.4250/jcvi.2018.26.e17

Cardiac Structural or Functional Changes Associated with CHA2DS2-VASc Scores in Nonvalvular Atrial Fibrillation: A Cross-Sectional Study Using Echocardiography  

Jang, Albert Youngwoo (Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center)
Yu, Jongwook (Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center)
Park, Ye Min (Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center)
Shin, Mi Seung (Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center)
Chung, Wook-Jin (Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center)
Moon, Jeonggeun (Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center)
Publication Information
Journal of Cardiovascular Imaging / v.26, no.3, 2018 , pp. 135-143 More about this Journal
Abstract
BACKGROUND: $CHA_2DS_2-VASc$ 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 $CHA_2DS_2-VASc$ 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 $CHA_2DS_2-VASc$ 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 $CHA_2DS_2-VASc$ 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') also increased significantly in the higher $CHA_2DS_2-VASc$ 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' (HR, 1.087; CI, 1.054-1.121; p < 0.001) were independent risk factors for $CHA_2DS_2-VASc$ scores 2 or higher. CONCLUSIONS: Our findings suggest that increasing $CHA_2DS_2-VASc$ scores are associated with impaired diastolic function that may represent high left atrial pressure favoring thrombogenic propensity.
Keywords
Atrial fibrillation; Left ventricular hypertrophy; $CHA_2DS_2-VASc$ score; Diastolic dysfunction; Hypertension;
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