Association of CHADS2, CHA2DS2-VASc, and R2CHADS2 Scores With Left Atrial Dysfunction in Patients With Coronary Heart Disease (from the Heart and Soul Study) - 13/03/14

Abstract |
The predictive ability of the CHADS2 index to stratify stroke risk may be mechanistically linked to severity of left atrial (LA) dysfunction. This study investigated the association between the CHADS2 score and LA function. We performed resting transthoracic echocardiography in 970 patients with stable coronary heart disease and normal ejection fraction and calculated baseline LA functional index (LAFI) using a validated formula: (LA emptying fraction × left ventricular outflow tract velocity time integral)/LA end-systolic volume indexed to body surface area. We performed regression analyses to evaluate the association between risk scores and LAFI. Among 970 subjects, mean CHADS2 was 1.7 ± 1.2. Mean LAFI decreased across tertiles of CHADS2 (42.8 ± 18.1, 37.8 ± 19.1, 36.7 ± 19.4, p <0.001). After adjustment for age, sex, race, systolic blood pressure, hyperlipidemia, myocardial infarction, revascularization, body mass index, smoking, and alcohol use, high CHADS2 remained associated with the lowest quartile of LAFI (odds ratio 2.34, p = 0.001). In multivariable analysis of component co-morbidities, heart failure, age, and creatinine clearance <60 ml/min were strongly associated with LA dysfunction. For every point increase in CHADS2, the LAFI decreased by 4.0%. Secondary analyses using CHA2DS2-VASc and R2CHADS2 scores replicated these results. Findings were consistent when excluding patients with baseline atrial fibrillation. In conclusion, CHADS2, CHA2DS2-VASc, and R2CHADS2 scores are associated with LA dysfunction, even in patients without baseline atrial fibrillation. These findings merit further study to determine the role of LA dysfunction in cardioembolic stroke and the value of LAFI for risk stratification.
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| Dr. Turakhia is supported by a Grant CDA09027-1 from the Veterans Health Services Research & Development Career Development Award, a Grant 09SDG2250647 from the American Heart Association National Scientist Development Grant, and a Grant IIR 09-092 from the VA Health Services and Development MERIT Award. The content and opinions expressed are solely the responsibility of the authors and do not necessarily represent the views or policies of the Department of Veterans Affairs. |
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| See page 1171 for disclosure information. |
Vol 113 - N° 7
P. 1166-1172 - avril 2014 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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