Cardiovasc Prev Pharmacother.  2020 Apr;2(2):56-62. 10.36011/cpp.2020.2.e9.

CHA₂DS₂-VASc Score Is Correlated with Cardiac Performance in Chronic Atrial Fibrillation

• Jeon DS
• Kim MJ
• Lee W
• Lee D
• Choi IJ

• KMID: 2536975
• DOI: http://doi.org/10.36011/cpp.2020.2.e9

Abstract

Background
The CHA₂DS₂-VASc score is a popular tool for risk prediction of thromboembolism in patients with atrial fibrillation (AF). Each component of the CHA₂DS₂-VASc scheme is an established risk factor for left ventricular diastolic dysfunction and heart failure (HF). In AF patients, HF is often adversely affecting to clinical outcomes including thromboembolism. We hypothesized that the CHA₂DS₂-VASc score reflects cardiac reserve and the risk of HF as well as the risk of stroke in patients with AF.
Methods
A total of 103 patients who had the diagnosis of chronic non-valvular AF patients with preserved ejection fraction (EF) were enrolled consecutively. CHA₂DS₂-VASc score was compared to exercise capacity (peak oxygen uptake, peak VO₂), B-type natriuretic peptide (BNP) and echocardiographic diastolic dysfunction index (early mitral to annular velocity, E/E′) ratio.
Results
Exercise capacity was correlated with age (β=−0.568, p<0.001), CHA₂DS₂-VASc score (β=−0.526, p<0.001), BNP (β=−0.449, p<0.001) and diastolic dysfunction (β=−0.534, p<0.001). Patients with CHA₂DS₂-VASc score ≥2 had a significantly less exercise capacity than those with CHA₂DS₂-VASc score <2 (p<0.001). Higher CHA₂DS₂-VASc score was associated with lower exercise capacity, more diastolic dysfunction and higher BNP (for trend p=0.001).
Conclusions
High CHA₂DS₂-VASc score is associated with poor exercise capacity in patients with AF. Diastolic dysfunction is thought to be the major mechanism of exercise limitation. CHA₂DS₂-VASc score might be useful for predicting overall cardiac reserve as well as stroke risk stratification in AF patients.

Keyword

Atrial fibrillation; Exercise test; Exercise tolerance; Heart failure, diastolic; Physical functional performance

Figure

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  Figure 1. Correlation of CHA2DS2-VASc score and cardiac reserve including exercise capacity. CHA2DS2-VASc score showed significant correlation with exercise capacity indicated by peak VO2 (A), diastolic dysfunction (B), and BNP (C).BNP = B-type natriuretic peptide; E/E′ = early mitral flow velocity/mitral annular velocityVO2 = oxygen uptake.

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