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Arrhythmias and sudden death
Original research article
CHA2DS2-VASc score, left atrial size and atrial fibrillation as stroke risk factors in the Tromsø Study
  1. Sweta Tiwari1,
  2. Maja-Lisa Løchen1,
  3. Bjarne K Jacobsen1,
  4. Laila A Hopstock1,2,
  5. Audhild Nyrnes1,
  6. Inger Njølstad1,
  7. Ellisiv B Mathiesen3,4 and
  8. Henrik Schirmer3,5
  1. 1Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
  2. 2Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
  3. 3Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
  4. 4Department of Neurology and Neurophysiology, The University Hospital of North Norway, Tromsø, Norway
  5. 5Division of Cardiothoracic and Respiratory Medicine, Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
  1. Correspondence to Sweta Tiwari; sweta.tiwari{at}uit.no

Abstract

Objective CHA2DS2-VASc score, left atrial (LA) size and atrial fibrillation (AF) have individually been associated with stroke risk. Our aim was to investigate the predictive ability of combinations of these factors for the odds of incident stroke in a population-based cohort study.

Methods We followed 2844 participants from the Tromsø Study from 1994 to 2012. Information on LA size and CHA2DS2-VASc score (age, sex, congestive heart failure, hypertension, vascular disease, stroke and diabetes) were obtained at baseline. AF status was recorded from medical records. The outcome measure was all strokes. The association between covariates and stroke was investigated by means of multivariate logistic regression analysis.

Results A total of 325 participants (45% women, mean age at baseline 59.3 years) had a stroke. Incidence rates for stroke were 6.4 in women and 8.4 in men per 1000 person-years. Participants with CHA2DS2-VASc ≥1 and LA size <2.8 had ∼4 times (95% CI 2.6 to 5.3) increased odds of stroke, whereas participants with CHA2DS2-VASc ≥1 and LA size ≥2.8 had ∼9 times (95% CI 5.3 to 16.4) increased odds of stroke, compared with participants with CHA2DS2-VASc score 0, irrespective of AF status. Adjustment for significant covariates had minimal impact on the OR estimates.

Conclusions Combining CHA2DS2-VASc score ≥1 and enlarged LA size identified participants with high odds of stroke regardless of AF status.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2016-000439

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