Finding low CHA2DS2-VASc scores unreliable? Why not give morphological and hemodynamic methods a try?

Sun, YiRen; Lu, Yang; Chen, Zijia; Wang, Zhengjie; Li, Tao; Qi, Tao; Qian, Yongjun

doi:10.3389/fcvm.2022.1032736

Cited by 7 publications

(4 citation statements)

References 62 publications

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“…Those results based on CHA 2 DS 2 -VASc score failed to provide patient-centered estimates of outcome risks with versus without the intervention and taking into account all relevant patient attributes simultaneously [32] . One reason why the CHA2DS2-VASc score may not be suitable for stratifying treatment effects is that it has limited predictive value, especially in those with low scores [33] . A better approach to reach this issue might be developing a new tool to examine heterogeneity in treatment effects, as Karwath, et al did in their study [34] .…”

Section: Discussionmentioning

confidence: 99%

Early rhythm control strategy in early atrial fibrillation patients, a retrospective cohort study.

Liu,

Chen,

Lin

et al. 2023

Preprint

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Introduction: Atrial fibrillation (AF) treatment strategy on whether to use rhythm control or usual care (UC) has been debated for decades. In early studies, these two strategies showed equivalent efficacy, but more recent studies based on CHA2DS2-VASc score indicated that early rhythm control (ERC) would benefit more than UC strategy. We hypothesized that ERC might benefit AF patients in other cardiovascular outcomes, regardless of CHA2DS2-VASc score. To clarify this, we conducted the current study. Methods: A retrospective cohort study was carried out using the Yinzhou Regional Health Care Database (YRHCD). We included all patients diagnosed with AF within 1 year, while excluding those without age/sex information, no ERC/UC treatment prescription, or with ongoing cancer. The primary outcome was major cardiovascular events (MACE). We used inverse probability of treatment weighting (IPTW) for covariates weighting. Results: In total, 7,161 patients diagnosed with early AF were included in this study, 2,248 and 4,913 were in ERC group and usual care group, respectively. During mean follow-up period 3.2 years (27,945 person-year), and after IPTW, the result remained similar for ERC showed significantly lower risk for MACE (HR: 0.75[0.61, 0.96], P=0.02), and heart failure (HR: 0.71[0.54,0.95], P=0.01). No significant results were found in stroke, cardiovascular death, or all-cause mortality. Conclusion: Early rhythm control is more beneficial to early AF patients than usual care for major cardiovascular events.

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Section: Discussionmentioning

confidence: 99%

Early rhythm control strategy in early atrial fibrillation patients, a retrospective cohort study.

Liu,

Chen,

Lin

et al. 2023

Preprint

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“…Thrombotic and embolic risk stratification in pregnant women is similar to that of non-pregnant women, since pregnancy is not included as a risk factor in the commonly used scores [ 70 ]. Moreover, the

-VASC has not been validated for pregnant women and is thought to underestimate the risk of stroke in pregnant females with AF [ 104 , 105 , 106 ]. Nevertheless, it is currently the only score system recommended for pregnant women [ 4 ].…”

Section: Anticoagulationmentioning

confidence: 99%

The Challenge of Managing Atrial Fibrillation during Pregnancy

Lucà,

Oliva,

Abrignani

et al. 2023

Rev. Cardiovasc. Med.

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The incidence of atrial fibrillation (AF) during pregnancy increases with maternal age and with the presence of structural heart disorders. Early diagnosis and prompt therapy can considerably reduce the risk of thromboembolism. The therapeutic approach to AF during pregnancy is particularly challenging, and the maternal and fetal risks associated with the use of antiarrhythmic and anticoagulant drugs must be carefully evaluated. Moreover, the currently used thromboembolic risk scores have yet to be validated for the prediction of stroke during pregnancy. At present, electrical cardioversion is considered to be the safest and most effective strategy in women with hemodynamic instability. Beta-selective blockers are also recommended as the first choice for rate control. Antiarrhythmic drugs such as flecainide, propafenone and sotalol should be considered for rhythm control if atrioventricular nodal-blocking drugs fail. AF catheter ablation is currently not recommended during pregnancy. Overall, the therapeutic strategy for AF in pregnancy must be carefully assessed and should take into consideration the advantages and drawbacks of each aspect. A multidisciplinary approach with a “Pregnancy-Heart Team” appears to improve the management and outcome of these patients. However, further studies are needed to identify the most appropriate therapeutic strategies for AF in pregnancy.

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“…AFib patients are treated with anticoagulation medication to reduce their thrombotic risk, but the treatment increases their bleeding risk (6). The current tools to assess whether anticoagulation therapy is warranted for a particular patient (e.g., the CHA 2 DS 2 VASc score) are based on comorbid factors, which lack any mechanistic associations with thrombus formation, predictive accuracy, and personalization (7). Notably, the same metrics used to calculate CHA 2 DS 2 VASc are associated with fibrotic myocardial remodeling in response to tissue injury (8).…”

Section: Introductionmentioning

confidence: 99%

Patient-specific multi-physics simulations of fibrotic changes in left atrial tissue mechanics impact on hemodynamics

Gonzalo,

Augustin,

Bifulco

et al. 2024

Preprint

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Stroke is a leading cause of death and disability worldwide. Atrial myopathy, including fibrosis, is associated with an increased risk of ischemic stroke, but the mechanisms underlying this association are poorly understood. Fibrosis modifies myocardial structure, impairing electrical propagation and tissue biomechanics, and creating stagnant flow regions where clots could form. Fibrosis can be mapped non-invasively using late gadolinium enhancement magnetic resonance imaging (LGE-MRI). However, fibrosis maps are not currently incorporated into stroke risk calculations or computational electro-mechano-fluidic models. We present multi-physics simulations of left atrial (LA) myocardial motion and hemodynamics using patient-specific anatomies and fibrotic maps from LGE-MRI. We modify tissue stiffness and active tension generation in fibrotic regions and investigate how these changes affect LA flow for different fibrotic burdens. We find that fibrotic regions and, to a lesser extent, non-fibrotic regions experience reduced myocardial strain, resulting in decreased LA emptying fraction consistent with clinical observations. Both fibrotic tissue stiffening and hypocontractility independently reduce LA function, but together, these two alterations cause more pronounced effects than either one alone. Fibrosis significantly alters flow patterns throughout the atrial chamber, and particularly, the filling and emptying jets of the left atrial appendage (LAA). The effects of fibrosis in LA flow are largely captured by the concomitant changes in LA emptying fraction except inside the LAA, where a multi-factorial behavior is observed. This work illustrates how high-fidelity, multi-physics models can be used to study thrombogenesis mechanisms in a patient-specific manner, shedding light onto the link between atrial fibrosis and ischemic stroke.Key pointsLeft atrial (LA) fibrosis is associated with arrhythmogenesis and increased risk of ischemic stroke; its extent and pattern can be quantified on a patient-specific basis using late gadolinium enhancement magnetic resonance imaging.Current stroke risk prediction tools have limited personalization, and their accuracy could be improvedfib by incorporating patient-specific information like fibrotic maps and hemodynamic patterns.We present the first electro-mechano-fluidic multi-physics computational simulations of LA flow, including fibrosis and anatomies from medical imaging.Mechanical changes in fibrotic tissue impair global LA motion, decreasing LA and left atrial appendage (LAA) emptying fractions, especially in subjects with higher fibrosis burdens.Fibrotic-mediated LA motion impairment alters LA and LAA flow near the endocardium and the whole cavity, ultimately leading to more stagnant blood regions in the LAA.

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Finding low CHA2DS2-VASc scores unreliable? Why not give morphological and hemodynamic methods a try?

Cited by 7 publications

References 62 publications

Early rhythm control strategy in early atrial fibrillation patients, a retrospective cohort study.

Early rhythm control strategy in early atrial fibrillation patients, a retrospective cohort study.

The Challenge of Managing Atrial Fibrillation during Pregnancy

Patient-specific multi-physics simulations of fibrotic changes in left atrial tissue mechanics impact on hemodynamics

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