CHA₂DS₂-VASc score, left atrial size and atrial fibrillation as stroke risk factors in the Tromsø Study

Abstract

ObjectiveCHA2DS2-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.MethodsWe 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.ResultsA 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.ConclusionsCombining CHA2DS2-VASc score ≥1 and enlarged LA size identified participants with high odds of stroke regardless of AF status.

Relation of the CHA2DS2-VASc Score to Risk of Thrombotic and Embolic Stroke in Community-Dwelling Individuals Without Atrial Fibrillation (From The Atherosclerosis Risk in Communities [ARIC] Study)

“…17 Finally, ECG-defined left atrial abnormalities and left atrial enlargement have been shown to be associated with ischemic stroke, independent of AF. 11,18,19 The principal strengths of our study include a prospective community-based investigation with meticulous physician-adjudication of ischemic stroke, including classification of thrombotic and embolic stroke. Other strengths include inclusion of community non-white participants, extensive measurement of covariates, and large number of participants.…”

Can development of atrial fibrillation in patients with ischemic heart failure with low ejection fraction be predicted?

“…Previous studies have shown that an increase in left atrial diameter increases the incidence [20][21][22][23][24], recurrence, and the frequency of AF, parallel to an increase in the risk of stroke [23]. There is an increase in interstitial fibrosis within the atrial wall in HF, causing impaired conduction, which is the substrate for AF [25].…”

Atrial fibrillation is associated with cognitive decline in stroke‐free subjects: the Tromsø Study

“…Echocardiography was performed by two cardiologists on a random subsample ( n = 1722) in Tromsø 5 , using the standard apical and parasternal long‐ and short‐axis views. Standard two‐dimensional guided M‐mode registrations of anteroposterior LA size, internal dimensions of the left ventricle and wall thickness of the septum and posterior wall were made.…”

“…The CHA 2 DS 2 ‐VASc score estimates stroke risk in patients with non‐anticoagulated AF by combining risk factors for stroke. Based on data from the Tromsø Study, we have previously shown that adding left atrial (LA) size to an elevated CHA 2 DS 2 ‐VASc score provided additional stratification of stroke risk . In this study, we aimed to investigate the association between AF and cognitive function in a population study with 6 years of follow‐up of stroke‐free women and men.…”

“…: +47 77645352; fax: +47 77644831; e-mail: sweta.tiwari@uit.no). [7]. In this study, we aimed to investigate the association between AF and cognitive function in a population study with 6 years of follow-up of stroke-free women and men.…”