Arrhythmias and Conduction DisturbancesAssociation of CHADS2, CHA2DS2-VASc, and R2CHADS2 Scores With Left Atrial Dysfunction in Patients With Coronary Heart Disease (from the Heart and Soul Study)
Section snippets
Methods
The Heart and Soul Study is a prospective cohort study of psychosocial factors and health outcomes in patients with coronary heart disease (CHD). Details regarding recruitment methods and study design have been previously published.12 From September 2000 to December 2002, 1,024 outpatient subjects were recruited from 2 Department of Veterans Affairs medical centers (San Francisco Veterans Affairs Medical Center and the Veterans Affairs Palo Alto Health Care System), a university medical center
Results
The cohort consisted of 970 subjects (180 women). Baseline characteristics across tertiles of CHADS2 are listed in Table 1. The mean (±SD) CHADS2 score was 1.7 ± 1.2; 464 (48%) had scores of 0 to 1, 407 (42%) had scores of 2 to 3, and 99 (10%) had scores of 4 to 6. There was no significant difference in sex, race, or AF prevalence across tertiles of CHADS2. Compared with those with low (0 to 1) CHADS2 scores, subjects with intermediate (2 to 3) and high (≥4) scores were more likely to have
Discussion
In a cohort of 970 predominantly male outpatients with stable CHD, we found that higher CHADS2 scores were associated with LA dysfunction as measured by the LAFI. Higher CHADS2 predicts lower LAFI independent of age, sex, smoking, or alcohol use. This association was replicated when employing CHA2DS2-VASc and R2CHADS2 indices.
There are several potential explanations for these observations. The overall correlation between stroke risk and LA dysfunction likely reflects the known association
Disclosures
The authors have no conflicts of interest to disclose.
References (30)
- et al.
Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro heart survey on atrial fibrillation
Chest
(2010) - et al.
Antithrombotic therapy in atrial fibrillation: American College of Chest Physicians evidence-based clinical practice guidelines (8th Edition)
Chest
(2008) - et al.
The CHADS2 score predicts ischemic stroke in the absence of atrial fibrillation among subjects with coronary heart disease: data from the Heart and Soul Study
Am Heart J
(2011) - et al.
Electrophysiologic and electroanatomic changes in the human atrium associated with age
J Am Coll Cardiol
(2004) - et al.
Fibrosis of the left atria during progression of heart failure is associated with increased matrix metalloproteinases in the rat
J Am Coll Cardiol
(2003) - et al.
Prevalence and prognosis of asymptomatic left ventricular diastolic dysfunction in ambulatory patients with coronary heart disease
Am J Cardiol
(2007) - et al.
Structural and functional remodeling of the left atrium: clinical and therapeutic implications for atrial fibrillation
J Am Coll Cardiol
(2008) - et al.
Left atrial volume: important risk marker of incident atrial fibrillation in 1655 older men and women
Mayo Clin Proc
(2001) - et al.
Left atrial volume in the prediction of first ischemic stroke in an elderly cohort without atrial fibrillation
Mayo Clin Proc
(2004) - et al.
Temporal relationship of atrial tachyarrhythmias, cerebrovascular events, and systemic emboli based on stored device data: a subgroup analysis of TRENDS
Heart Rhythm
(2011)
Incidence of left atrial thrombi in patients in sinus rhythm and with a recent neurologic deficit
Am Heart J
Left atrial function predicts heart failure hospitalization in subjects with preserved ejection fraction and coronary heart disease: longitudinal data from the Heart and Soul Study
J Am Coll Cardiol
Impaired left atrial mechanical function after cardioversion: relation to the duration of atrial fibrillation
J Am Coll Cardiol
Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation
JAMA
Renal dysfunction as a predictor of stroke and systemic embolism in patients with nonvalvular atrial fibrillation: validation of the R(2)CHADS(2) index in the ROCKET AF (Rivaroxaban once-daily, oral, direct factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and embolism trial in atrial Fibrillation) and ATRIA (anticoagulation and risk factors in atrial fibrillation) study cohorts
Circulation
Cited by (14)
What Constitutes Truly Low Risk of Stroke?
2018, Journal of Emergency MedicineProposed rationale for anticoagulants in nonvalvular atrial fibrillation with zero CHA2DS2-Vasc score
2018, International Journal of CardiologyEditorial Commentary: The holy grail of atrial fibrillation
2017, Trends in Cardiovascular MedicinePrediction of vascular dementia and Alzheimer's disease in patients with atrial fibrillation or atrial flutter using CHADS<inf>2</inf> score
2016, Journal of the Chinese Medical AssociationCitation Excerpt :Both vascular dementia and AD had been reported to be associated with AF. CHADS2 has been reported to be of use for risk stratification regarding stroke recurrence among patients with AF4 and has also been reported to predict AF recurrence after ablation and predict AF complications among AF patients.5,6 However, information about the use of CHADS2 score to predict dementia, including vascular dementia and AD, is limited.
Left Atrial Appendage Exclusion for Atrial Fibrillation
2016, Heart Failure ClinicsCitation Excerpt :In patients with AF, the best validated methods of identifying patients at increased risk of stroke, are the CHADS259,60 and CHA2DS2-VASc score,61,62 the constitutive components of which are mainly risk factors for vascular disease. A complex interaction exists between these scores, the presence of atherosclerotic arterial (especially aortic, mainly descending thoracic aorta) disease, increasing AF burden, progressive left atrial dysfunction, and LAA thrombus formation (see Fig. 2).63–77 One possible unifying mechanism is reduced aortic compliance, resulting in ventricular diastolic dysfunction from abnormal ventricular-vascular interactions.78
The CHADS2 Components Are Associated with Stroke-Related In-hospital Mortality in Patients with Atrial Fibrillation
2015, Journal of Stroke and Cerebrovascular Diseases
Dr. Turakhia is supported by a Grant CDA09027-1 from the Veterans Health Services Research & Development Career Development Award, a Grant 09SDG2250647 from the American Heart Association National Scientist Development Grant, and a Grant IIR 09-092 from the VA Health Services and Development MERIT Award. The content and opinions expressed are solely the responsibility of the authors and do not necessarily represent the views or policies of the Department of Veterans Affairs.
See page 1171 for disclosure information.