open access

Vol 25, No 1 (2018)
Original articles — Clinical cardiology
Published online: 2017-07-17
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Echocardiographic parameters versus CHA2DS2-VASc score in prediction of overall cardiac events, heart failure, and stroke in non-valvular atrial fibrillation

Li-Tan Yang, Wei-Chuan Tsai, Ho-Ming Su
DOI: 10.5603/CJ.a2017.0086
·
Pubmed: 28714523
·
Cardiol J 2018;25(1):60-71.

open access

Vol 25, No 1 (2018)
Original articles — Clinical cardiology
Published online: 2017-07-17

Abstract

 Background: Apart from stroke, atrial fibrillation (AF) is associated with higher mortality and heart failure (HF), in which risk stratification scheme is lacking. Therefore this investigation examined the prognostic value of echocardiographic predictors against CHA2DS2-VASc score in permanent non- -valvular AF (NVAF).

Methods: In 252 asymptomatic or mildly symptomatic consecutive patients with NVAF, comprehensive echocardiography was performed. Left atrial deformation parameters were also obtained by two-dimen­sional speckle tracking echocardiography. End-points pertaining to HF deterioration, ischemic stroke and cardiac death were recorded.

Results: There were 74 cardiovascular events, including 44 deterioration of HF, 22 ischemic strokes and 8 cardiovascular deaths during an average follow-up period of 20.8 ± 13.5 months (interquartile range, 8–31 months). For prediction of overall prognosis and HF, left ventricular mass index, peak early filling velocity (E), and E to tissue Doppler mitral annular early diastolic velocity ratio (E/e’) outper­formed CHA2DS2-VASc score in multivariate analysis, area under curve, and stepwise nested regression models. Left ventricular hypertrophy and E/e’ > 8 showed worse overall and heart-failure free survival in Kaplan-Meier curves. For prediction of ischemic stroke, the addition of E or E/e’ to CHA2DS2-VASc score provides extra prognostic value.

Conclusions: Echocardiographic parameters offer incremental value over CHA2DS2-VASc score for prediction of future cardiac events in NVAF. (Cardiol J 2018; 25, 1: 60–71)

Abstract

 Background: Apart from stroke, atrial fibrillation (AF) is associated with higher mortality and heart failure (HF), in which risk stratification scheme is lacking. Therefore this investigation examined the prognostic value of echocardiographic predictors against CHA2DS2-VASc score in permanent non- -valvular AF (NVAF).

Methods: In 252 asymptomatic or mildly symptomatic consecutive patients with NVAF, comprehensive echocardiography was performed. Left atrial deformation parameters were also obtained by two-dimen­sional speckle tracking echocardiography. End-points pertaining to HF deterioration, ischemic stroke and cardiac death were recorded.

Results: There were 74 cardiovascular events, including 44 deterioration of HF, 22 ischemic strokes and 8 cardiovascular deaths during an average follow-up period of 20.8 ± 13.5 months (interquartile range, 8–31 months). For prediction of overall prognosis and HF, left ventricular mass index, peak early filling velocity (E), and E to tissue Doppler mitral annular early diastolic velocity ratio (E/e’) outper­formed CHA2DS2-VASc score in multivariate analysis, area under curve, and stepwise nested regression models. Left ventricular hypertrophy and E/e’ > 8 showed worse overall and heart-failure free survival in Kaplan-Meier curves. For prediction of ischemic stroke, the addition of E or E/e’ to CHA2DS2-VASc score provides extra prognostic value.

Conclusions: Echocardiographic parameters offer incremental value over CHA2DS2-VASc score for prediction of future cardiac events in NVAF. (Cardiol J 2018; 25, 1: 60–71)

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Keywords

atrial fibrillation, echocardiography, heart failure, prognosis, stroke

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About this article
Title

Echocardiographic parameters versus CHA2DS2-VASc score in prediction of overall cardiac events, heart failure, and stroke in non-valvular atrial fibrillation

Journal

Cardiology Journal

Issue

Vol 25, No 1 (2018)

Pages

60-71

Published online

2017-07-17

DOI

10.5603/CJ.a2017.0086

Pubmed

28714523

Bibliographic record

Cardiol J 2018;25(1):60-71.

Keywords

atrial fibrillation
echocardiography
heart failure
prognosis
stroke

Authors

Li-Tan Yang
Wei-Chuan Tsai
Ho-Ming Su

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