Atrial Fibrillation Significantly Increases Total Mortality and Stroke Risk Beyond that Conveyed by the CHADS2 Risk Factors

Abstract

The CHADS2 score is a powerful predictor of stroke and death. AF increases the risk of these outcomes in an independent manner. These data support the concept that AF is a risk factor of future cardiovascular disease.

Echocardiographic parameters versus CHA2DS2-VASc score in prediction of overall cardiac events, heart failure, and stroke in non-valvular atrial fibrillation

“…Atrial fibrillation independently adds risks to future cardiac events including death, stroke, myocardial infarction and HF exacerbation [3]. Most efforts have been exerted on stroke prediction and prevention, leading to the refinement of CHADS 2 score to CHA 2 DS 2 -VASc score as well as the emergence of new-generation oral anticoagulants.…”

“…Serial electrocardiograms, Holter recordings, and the medical records were used to confirm that AF had lasted for more than 1 year. Patients excluded were those with: (1) New York Heart Association functional classification (NYHA) III or IV, (2) infiltrative cardiomyopathy, (3) prior open heart surgery, (4) pacemaker implantation, (5) congenital heart disease, (6) end-stage renal disease or liver cirrhosis, and (7) malignancy. Patients with incomplete image acquisition and less than 6-month follow-up were not enrolled (Fig.…”

“…LV hypertrophy (LVH) was defined as LV mass index (LVMi) ≥ 115 g/m 2 in men and ≥ 95 g/m 2 in women [10]. The maximal LA volume during LV end-systole (LAVs) and the minimal LA volume during LV end-diastole (LAVd) were used to calculate LA total emptying fraction (LAEF), signified as [(LAVs -LAVd) / LAVs] × × 100% [3]. LAVi was obtained by LAVs indexed by body surface area.…”

“…LV end-diastolic volume (LVEDV) and LV end-systolic volume (LVESV), which were measured from the apical 4-and 2-chamber views using Simpson's biplane method, were indexed by the body surface area to obtain LVEDV index (LVEDVi) and LVESV index (LVESVi) [10]. LV mass was measured at end-diastole on M-mode recordings obtained in the parasternal long-axis view and calculated with the Devereux formula [3]. LV hypertrophy (LVH) was defined as LV mass index (LVMi) ≥ 115 g/m 2 in men and ≥ 95 g/m 2 in women [10].…”

“…It suggests that studying the contributors of AF-related adverse cardiac events and HF is as paramount as that of stroke. Although CHA 2 DS 2 -VASc score appears to be helpful in this aspect by some studies [3,4], it was not generally applied for this purpose. In addition, current guidance does not stress HF prediction and there lacks a risk scheme to tackle this conundrum [5].…”