J Cardiovasc Imaging.  2018 Sep;26(3):135-143. 10.4250/jcvi.2018.26.e17.

Cardiac Structural or Functional Changes Associated with CHAâ‚‚DSâ‚‚-VASc Scores in Nonvalvular Atrial Fibrillation: A Cross-Sectional Study Using Echocardiography

Affiliations
  • 1Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea. jeff76@gilhospital.com

Abstract

BACKGROUND
CHA2DS2-VASc is the most widely accepted scoring system for atrial fibrillation (AF) to assess stroke risk, although little has been revealed regarding the accompanying cardiac functional/structural changes. This echocardiography study was undertaken to understand the changes related to CHA2DS2-VASc scores.
METHODS
A total of 4,795 nonvalvular AF patients were enrolled for the cohort, from which 591 were excluded as they did not meet the inclusion criteria. Based on the CHA2DS2-VASc scores, the remaining 4,204 patients included in the study were divided into 4 groups: 0 to 1 (n = 991); 2 to 3 (n = 1,642); 4 to 6 (n = 1,407); 7 to 9 (n = 164).
RESULTS
Increase in the left ventricular mass index and prevalence of left ventricular hypertrophy (LVH) were observed with elevating CHA2DS2-VASc scores (p < 0.05 for all). Diastolic parameters such as left atrial volume index (LAVI) and the ratio of early diastolic mitral inflow velocity to early diastolic velocity of the mitral annulus (E/E"²) also increased significantly in the higher CHA2DS2-VASc score groups (p < 0.001 for all), although two-way ANOVA analysis showed that such incremental diastolic impairment was independent of hypertension. LVH (hazard ratio [HR], 3.609; confidence interval [CI], 2.426-5.369; p < 0.001) and E/E"² (HR, 1.087; CI, 1.054-1.121; p < 0.001) were independent risk factors for CHA2DS2-VASc scores 2 or higher.
CONCLUSIONS
Our findings suggest that increasing CHA2DS2-VASc scores are associated with impaired diastolic function that may represent high left atrial pressure favoring thrombogenic propensity.

Keyword

Atrial fibrillation; Left ventricular hypertrophy; CHAâ‚‚DSâ‚‚-VASc score; Diastolic dysfunction; Hypertension

MeSH Terms

Atrial Fibrillation*
Atrial Pressure
Cohort Studies
Cross-Sectional Studies*
Echocardiography*
Humans
Hypertension
Hypertrophy, Left Ventricular
Prevalence
Risk Factors
Stroke

Figure

  • Figure 1 Diagram for detalied enrollement of patients. A total of 4,795 patients were enrolled for the cohort. After excluding 591 patients with either missing data or valvular disease or surgery, 4,204 patients were allocated in each group according to their CHA2DS2 VASc scores.

  • Figure 2 Trends of each echocardiographic parameter. Tukey's post hoc test results for left ventricular mass index (A), left atrial dimension (B), left atrial volume index (C), and the ratio of early diastolic mitral inflow velocity to early diastolic velocity of the mitral annulus (D) are shown. E/E′: the ratio of early diastolic mitral inflow velocity to early diastolic velocity of the mitral annulus, LAD: left atrial anterior posterior dimension, LAVI: left atrial volume index, LVMI: left ventricular mass index. *p < 0.05.


Reference

1. Camm AJ, Kirchhof P, Lip GY, et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Europace. 2010; 12:1360–1420.
2. Akar JG, Marieb MA. Atrial fibrillation and thrombogenesis: innocent bystander or guilty accomplice? JACC Clin Electrophysiol. 2015; 1:218–219.
3. Di Tullio MR, Sacco RL, Sciacca RR, Homma S. Left atrial size and the risk of ischemic stroke in an ethnically mixed population. Stroke. 1999; 30:2019–2024.
Article
4. Watson T, Shantsila E, Lip GY. Mechanisms of thrombogenesis in atrial fibrillation: Virchow's triad revisited. Lancet. 2009; 373:155–166.
Article
5. Gupta DK, Giugliano RP, Ruff CT, et al. The prognostic significance of cardiac structure and function in atrial fibrillation: The ENGAGE AF-TIMI 48 Echocardiographic Substudy. J Am Soc Echocardiogr. 2016; 29:537–544.
6. Olesen JB, Lip GY, Hansen ML, et al. Validation of risk stratification schemes for predicting stroke and thromboembolism in patients with atrial fibrillation: nationwide cohort study. BMJ. 2011; 342:d124.
Article
7. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014; 63:2438–2488.
8. Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005; 18:1440–1463.
Article
9. Cohn JN, Ferrari R, Sharpe N. Cardiac remodeling--concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. Behalf of an International Forum on Cardiac Remodeling. J Am Coll Cardiol. 2000; 35:569–582.
10. Jia X, Levine GN, Birnbaum Y. The CHA2DS2-VASc score: Not as simple as it seems. Int J Cardiol. 2018; 257:92–96.
11. Cuspidi C, Sala C, Negri F, Mancia G, Morganti A. Italian Society of Hypertension. Prevalence of left-ventricular hypertrophy in hypertension: an updated review of echocardiographic studies. J Hum Hypertens. 2012; 26:343–349.
Article
12. Eguchi K, Boden-Albala B, Jin Z, et al. Association between diabetes mellitus and left ventricular hypertrophy in a multiethnic population. Am J Cardiol. 2008; 101:1787–1791.
Article
13. Proietti M, Marra AM, Tassone EJ, et al. Frequency of left ventricular hypertrophy in non-valvular atrial fibrillation. Am J Cardiol. 2015; 116:877–882.
Article
14. Lim HS, Willoughby SR, Schultz C, et al. Thrombogenic risk in patients with atrial fibrillation: importance of comorbid conditions and intracardiac changes. JACC Clin Electrophysiol. 2015; 1:210–217.
15. Buono F, Crispo S, Pagano G, et al. Determinants of left ventricular hypertrophy in patients with recent diagnosis of essential hypertension. J Hypertens. 2014; 32:166–173.
Article
16. Gerdts E, Izzo R, Mancusi C, et al. Left ventricular hypertrophy offsets the sex difference in cardiovascular risk (the Campania Salute Network). Int J Cardiol. 2018; 258:257–261.
Article
17. Goldman ME, Pearce LA, Hart RG, et al. Pathophysiologic correlates of thromboembolism in nonvalvular atrial fibrillation: I. Reduced flow velocity in the left atrial appendage (The Stroke Prevention in Atrial Fibrillation [SPAF-III] study). J Am Soc Echocardiogr. 1999; 12:1080–1087.
Article
18. Ha JW, Lee BK, Kim HJ, et al. Assessment of left atrial appendage filling pattern by using intravenous administration of microbubbles: comparison between mitral stenosis and mitral regurgitation. J Am Soc Echocardiogr. 2001; 14:1100–1106.
Article
19. Shively BK, Gelgand EA, Crawford MH. Regional left atrial stasis during atrial fibrillation and flutter: determinants and relation to stroke. J Am Coll Cardiol. 1996; 27:1722–1729.
20. Schotten U, Verheule S, Kirchhof P, Goette A. Pathophysiological mechanisms of atrial fibrillation: a translational appraisal. Physiol Rev. 2011; 91:265–325.
Article
21. Kim H, Park YA, Choi SM, et al. Associates and prognosis of giant left atrium; single center experience. J Cardiovasc Ultrasound. 2017; 25:84–90.
Article
22. Okin PM, Wachtell K, Devereux RB, et al. Regression of electrocardiographic left ventricular hypertrophy and decreased incidence of new-onset atrial fibrillation in patients with hypertension. JAMA. 2006; 296:1242–1248.
Article
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