CHADS₂ and CHA₂DS₂-VASc Scores Predict the Risk of Ischemic Stroke Outcome in Patients with Interatrial Block without Atrial Fibrillation

Abstract

Aim: To evaluate the role of CHADS2 and CHA2DS2-VASc scores in predicting the risk of ischemic stroke or transient ischemic attack (TIA) outcomes in patients with interatrial block (IAB) without a history of atrial fibrillation (AF).Methods: A retrospective study was conducted, including 1,046 non-anticoagulated inpatients (612 males, 434 females; mean age: 63 ± 10 years) with IAB and without AF. IAB was defined as P-wave duration > 120 ms using a 12-lead electrocardiogram. CHADS2 and CHA2DS2-VASc scores were retrospectively calculated. The primary outcomes evaluated were ischemic stroke or TIA.Results: During the mean follow-up period of 4.9 ± 0.7 years, 55 (5.3%) patients had an ischemic stroke or TIA. Receiver operating characteristic (ROC) curve analysis showed that the CHADS2 score [area under the curve (AUC), 0.638; 95% confidence interval (CI), 0.562–0.715; P = 0.001] and the CHA2DS2-VASc score (AUC, 0.671; 95% CI, 0.599–0.744; P <0.001) were predictive of ischemic strokes or TIA. Cut-off point analysis showed that a CHADS2 score ≥ 3 (sensitivity = 0.455 and specificity = 0.747) and a CHA2DS2-VASc score ≥ 4 (sensitivity = 0.564 and specificity = 0.700) provided the highest predictive value for ischemic stroke or TIA. The multivariate Cox regression analysis showed that CHADS2 [hazard ratio (HR), 1.442; 95% CI, 1.171–1.774; P = 0.001] and CHA2DS2-VASc (HR, 1.420; 95% CI, 1.203–1.677; P <0.001) scores were independently associated with ischemic stroke or TIA following adjustment for smoking, left atrial diameter, antiplatelet agents, angiotensin inhibitors, and statins.Conclusions: CHADS2 and CHA2DS2-VASc scores may be predictors of risk of ischemic stroke or TIA in patients with IAB without AF.

Association Between CHADS₂ Score and the Development of Interatrial Block

“…1) A recent review of the prevalence of IAB described this condition as being an under-appreciated clinical pandemic, particularly in the aging population. 2) IAB can be associated with a multitude of medical conditions, including atrial fibrillation (AF), [3][4][5][6][7][8] left atrial electromechanical dysfunction, 1,9) thromboembolic ischemic stroke, [10][11][12][13] and increased cardiovascular and all-cause mortalities. 14) Therefore, it is crucial that patients who are at an increased risk for developing IAB are identified.…”

Anticoagulation in patients at high risk of stroke without documented atrial fibrillation. Time for a paradigm shift?

“…Wu et al. () also found this association between IAB and stroke in patients with high CHA 2 DS 2 ‐V score. Finally, Martínez‐Sellés, Massó‐van Roessel, et al., found that centenarians with IAB presented a higher prevalence of cognitive impairment and previous stroke than centenarians with normal P wave.…”

Rationale and design of the BAYES (Interatrial Block and Yearly Events) registry

“…In 2012, a consensus paper defined the current ECG diagnostic criteria: partial IAB (P‐wave duration ≥120 ms) and advanced IAB (P‐wave duration ≥120 ms plus biphasic [plus/minus] morphology in inferior leads II, III, and aVF). The interest in this topic has increased in recent years, and a large number of studies recently have been published regarding the prevalence of IAB and its associations with the risk of AF, ischemic stroke, and cognitive decline . However, most studies have been performed retrospectively in the general population, where, even in the presence of IAB, the incidence of AF and stroke is low.…”

“…The interest in this topic has increased in recent years, and a large number of studies recently have been published regarding the prevalence of IAB and its associations with the risk of AF, ischemic stroke, and cognitive decline. [7][8][9][10][11][12][13][14][15] However, most studies have been performed retrospectively in the general population, where, even in the presence of IAB, the incidence of AF and stroke is low. Little information exists about the prognosis of elderly patients with heart disease and IAB.…”