Preadmission CHA2DS2-VASc Scores on Diastolic Function and Functional Outcome After Stroke with Nonvalvular Atrial Fibrillation

TL;DR

Higher preadmission CHA2DS2-VASc scores are linked to worse functional outcomes in stroke patients with nonvalvular atrial fibrillation.

Contribution

This study shows that the CHA2DS2-VASc score predicts functional outcomes better than diastolic dysfunction severity in stroke patients with nonvalvular AF.

Findings

Higher CHA2DS2-VASc scores were associated with more severe left ventricular diastolic dysfunction.

CHA2DS2-VASc scores predicted unfavorable functional outcomes (mRS ≥ 3) more effectively than LVDD severity.

The C-statistic for predicting mRS ≥ 3 was 0.80, indicating strong predictive ability.

Abstract

Background/Objective: Atrial fibrillation (AF) is associated with more grave and fatal outcomes than the other stroke etiologies. Left ventricular diastolic dysfunction (LVDD) is prevalent in elderly people and is associated with AF risk. We investigated whether higher preadmission CHA2DS2-VASc score is related to LVDD severity and functional outcome among stroke patients with nonvalvular AF. Methods: A retrospective cross-sectional analysis of data on consecutive acute ischemic stroke patients with AF within a week of onset was conducted from March 2015 to February 2018. Patients were compared by median LVDD value (13.0). CHA2DS2-VASc was assessed by score, with three categories (low risk [a CHA2DS2-VASc score of 0–2], moderate risk [3,4], and high risk [≥5]), and its individual component. Functional outcome was measured with the modified Rankin Scale (mRS) at 3 months poststroke, and unfavorable outcome was defined as mRS ≥ 3. Results: A total of 256 patients (mean age, 73.3 ± 10.2; male, 51.6%) were included. In multivariable regression analysis, CHA2DS2-VASc was associated with LVDD (OR 1.70, 95% CI: 1.31–2.21 for score and 9.92, 2.99–32.88 for high risk ≥ 5 versus low risk 0–2). Increasing CHA2DS2-VASc score and high risk ≥ 5 versus low risk 0–2 was associated with mRS ≥ 3 (1.72, 1.27–2.33 and 6.48, 1.37–30.60, respectively). The C-statistic of the CHA2DS2-VASc score was 0.75 (0.70–0.80) for LVDD and 0.80 (0.75–0.85) for mRS ≥ 3. The sensitivity of the CHA2DS2-VASc score for mRS ≥ 3 was higher than for LVDD. Conclusions: Higher preadmission CHA2DS2-VASc score can be a cumulative determinant of short-term functional outcome more than LVDD severity among stroke patients with nonvalvular AF.

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