Investigation of Stroke Risk Factors and Prognostic Indicators in NVAF Patients with Low CHA₂DS₂-VASc Scores

Abstract

The prognosis of patients with nonvalvular atrial fibrillation (NVAF) with a low CHA2DS2-VASc score (0-1) following a stroke is not well studied. In this investigation, stroke risk factors and prognostic markers in lowrisk NVAF patients who are nonetheless at risk for stroke were examined.From January 2012 to January 2022, we retrospectively assessed atrial fibrillation (AF) patients at Xiamen University's Zhongshan Hospital for ischemic stroke. Along with a control group of patients with CHA2DS2-VASc scores of 0-1 who weren't suffering from a stroke, patients with CHA2DS2-VASc scores of 0-1 at the time of stroke were included in the study. Using multivariate logistic regression, independent risk factors were identified. To assess the cumulative occurrences of in-hospital mortality in patients with NVAF-related stroke, the Kaplan-Meier method was used.The study included 156 out of 3.237 inpatients with AF-related stroke who had CHA2DS2-VASc ratings of 0-1. Left atrial diameter (LAD) (odds ratio [OR]: 1.858, 95% confidence interval (CI) 1.136-3.036, P = 0.013), D-dimer (OR: 2.569, 95% CI 1.274-5.179, P = 0.008), and NT-proBNP (OR: 4.558, 95% CI 2.060-10.087, P = 0.000) were found to be independent risk factors for stroke in NVAF patients with a low CHA2DS2-VASc score. During hospitalization, nine patients with NVAF-related stroke died. In patients with NVAF-related stroke, NT-proBNP (hazard ratio: 3.504, 95% CI 1.079-11.379, P = 0.037) was an indicator of mortality risk.Patients with NVAF and CHA2DS2-VASc scores of 0-1 had independent risk factors for stroke in the form of LAD, D-dimer, and NT-proBNP. Notably, in low-risk NVAF patients with stroke, NT-proBNP was discovered to be a potent predictor of in-hospital death.

Impact of left ventricular diastolic function and direct oral anticoagulant use for predicting embolic events in patients with heart failure and atrial fibrillation

“…Indeed, a small number of strokes have been reported even in patients with a low CHADS 2 score. 33 , 34 The guidelines recommend continued anticoagulation if the CHADS 2 score is >2 after catheter ablation, 35 but it may be advisable to continue anticoagulation even in patients with no improvement in E/e'. Our present findings also suggest that the LA appendage should be routinely evaluated for thrombus before initiation of rhythm control in elderly patients with an elevated E/e' and not on a DOAC (including those on warfarin).…”

“…Indeed, a small number of strokes have been reported even in patients with a low CHADS 2 score. 33,34 The guidelines recommend continued anticoagulation if the CHADS 2 score is >2 after catheter ablation, 35 but it may be advisable to continue anticoagulation even in patients with no improvement in E/e'.…”