Heart failure: a weak link in CHA<sub>2</sub>DS<sub>2</sub>‐VASc

Friberg, Leif; Lund, Lars H.

doi:10.1002/ehf2.12262

Cited by 10 publications

(12 citation statements)

References 21 publications

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“…The clinical diagnostic component of the definition, evidence of HF, may be unreliable due to difficulty differentiating HF from lung or pulmonary vascular diseases. As clinical diagnoses are open to interpretation, some studies define CHF based on International Classification of Diseases (ICD) codes [5] while others including textbooks [6] do not specify clear criteria, leading to the need for a less ambiguous definition for CHF in the CHA 2 DS 2 -VASc scheme. A Meta-analysis demonstrated that out of 12 studies that define CHF as clinical heart failure, only 3 showed an association between CHF and the occurrence of stroke in patients with AF [4].…”

Section: Introductionmentioning

confidence: 99%

The Thromboembolic Predictability of CHA2DS2-VASc Scores Using Different Echocardiographic Criteria for Congestive Heart Failure in Korean Patients with Nonvalvular Atrial Fibrillation

Jang

Kang

Park

et al. 2022

JCM

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The association between congestive heart failure (CHF) of the CHA2DS2-VASc scores and thromboembolic (TE) events in patients with atrial fibrillation (AF) is a topic of debate due to conflicting results. As the importance of diastolic impairment in the occurrence of TE events is increasingly recognized, it is crucial to evaluate the predictive power of CHA2DS2-VASc scores with C criterion integrating diastolic parameters. We analyzed 4200 Korean nonvalvular AF patients (71 years of age, 59% men) to compare multiple echocardiographic definitions of CHF. Various guideline-suggested echocardiographic parameters for systolic or diastolic impairment, including left ventricular ejection fraction (LVEF) ≤ 40%, the ratio of early diastolic mitral inflow velocity to early diastolic velocity of the mitral annulus (E/E’) ≥ 11, left atrial volume index > 34 mL/m2, and many others were tested for C criteria. Multivariate-adjusted Cox regression analysis showed that CHA2DS2-VASc score was an independent predictor for composite thromboembolic events only when CHF was defined as E/E’ ≥ 11 (hazard ratio, 1.26; p = 0.044) but not with other criteria including the original definition (hazard ratio, 1.10; p = 0.359). Our findings suggest that C criterion defined as diastolic impairment, such as E/E’ ≥ 11, may improve the predictive value of CHA2DS2-VASc scores.

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Section: Introductionmentioning

confidence: 99%

The Thromboembolic Predictability of CHA2DS2-VASc Scores Using Different Echocardiographic Criteria for Congestive Heart Failure in Korean Patients with Nonvalvular Atrial Fibrillation

Jang

Kang

Park

et al. 2022

JCM

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“…However, these above-mentioned two scoring systems do not take into account other potential risk factors, such as renal function impairment, rheumatoid arthritis, obesity or smoking, nor do they consider clinically accessible laboratory indicators, imaging values and other parameters [ 11 , 12 ]. Friberg et al [ 13 ] have shown that clinically diagnosed heart failure does not increase rates of stroke in AF patients. Other studies have shown that left atrial enlargement and low-density lipoprotein cholesterol (LDL-C) are clinically easy-to-obtain indicators for risk stratification of thromboembolism events in patients with AF [ 14 – 16 ].…”

Section: Introductionmentioning

confidence: 99%

LDL-C/HDL-C is associated with ischaemic stroke in patients with non-valvular atrial fibrillation: a case-control study

et al. 2020

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Background This study explored the relationships between the low−/high-density lipoprotein cholesterol ratio (LDL-C/HDL-C) and other clinical indicators and ischaemic stroke (IS) in patients with non-valvular atrial fibrillation (NVAF) in Xinjiang. The findings could provide a theoretical and therapeutic basis for NVAF patients. Methods NVAF patients who were admitted to 10 medical centres across Xinjiang were divided into stroke (798 patients) and control (2671 patients) groups according to the occurrence of first acute IS. Univariate and multivariate logistic regression analysis were used to examine the independent risk factors for IS in NVAF patients. Factor analysis and principal component regression analysis were used to analyse the main factors influencing IS. Receiver operating characteristic (ROC) curve analysis was used to evaluate the discriminatory ability of LDL-C/HDL-C for predicting the occurrence of IS. Results The stroke group had an average age of 71.64 ± 9.96 years and included 305 females (38.22%). The control group had a mean age of 67.30 ± 12.01 years and included 825 females (30.89%). Multivariate logistic regression showed that the risk of IS in the highest LDL-C/HDL-C quartile (≥2.73) was 16.23-fold that of the lowest quartile (< 1.22); IS risk was 2.27-fold higher in obese patients than in normal-weight subjects; IS risk was 3.15-fold higher in smoking patients than in non-smoking patients. The area under the ROC curve of LDL-C/HDL-C was 0.76, the optimal critical value was 2.33, the sensitivity was 63.53%, and the specificity was 76.34%. Principal component regression analysis showed that LDL-C/HDL-C, age, smoking, drinking, LDL-C and hypertension were risk factors for IS in NVAF patients. Conclusions LDL-C/HDL-C > 1.22, smoking, BMI ≥24 kg/m2 and CHA2DS2-VASc score were independent risk factors for IS in NVAF patients; LDL-C/HDL-C was the main risk factor.

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“…However, the abovementioned two scoring systems do not take into account other potential risk factors, such as renal function impairment, rheumatoid arthritis, obesity or smoking, as well as clinically accessible laboratory indicators, imaging values and other parameters [4,5]. Friberg et al [6] have shown that clinically diagnosed heart failure is not an independent risk factor for stroke in AF patients. Previous studies have shown that left atrial enlargement and low-density lipoprotein cholesterol (LDL-C) are clinically easy-to-obtain indicators for risk strati cation of thromboembolism events in patients with AF [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

LDL-C/HDL-C is Associated With Ischaemic Stroke in Patients With Non-Valvular Atrial Fibrillation: A Case-Control Study

Zhang

Meng

Shang

et al. 2020

Preprint

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Background This study explored relationships between low-/high-density lipoprotein cholesterol ratio (LDL-C/HDL-C) and other clinical indicators and ischaemic stroke (IS) in non-valvular atrial fibrillation (NVAF) patients in Xinjiang, which could provide a theoretical and therapeutic basis for patients with NVAF. Methods NVAF patients who were admitted to 10 medical centres across Xinjiang were divided into the stroke (798 patients) and control (2671 patients) groups according to whether acute IS occurred. Univariate and multivariate logistic regression analysis was used to examine the independent risk factors for IS in NVAF patients. We used factor analysis and principal component regression analysis to analyse the main influencing factors of IS. Receiver operating characteristic (ROC) curve analysis was used to evaluate the optimal cut-off value of LDL-C/HDL-C in predicting IS. Results Multivariate logistic regression showed that the risk of IS in the highest quartile of LDL-C/HDL-C (≥ 2.73) was 16.23-fold that in the lowest quartile (< 1.22); IS risk was 2.27-fold higher in obese patients (BMI ≥ 28 kg/m2) than in normal-weight subjects; IS risk was 3.15-fold higher in smoking than in non-smoking patients. The area under the ROC curve of LDL-C/HDL-C was 0.76, optimal critical value was 2.33, sensitivity was 63.53%, and specificity was 76.34%. Principal component regression analysis showed that LDL-C/HDL-C, age, smoking, drinking, LDL-C and hypertension were risk factors for IS in NVAF patients. Conclusions LDL-C/HDL-C > 1.22, smoking and BMI ≥ 24 kg/m2 were independent risk factors for IS in NVAF patients, of which LDL-C/HDL-C was the main risk factor.

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Heart failure: a weak link in CHA₂DS₂‐VASc

Cited by 10 publications

References 21 publications

The Thromboembolic Predictability of CHA2DS2-VASc Scores Using Different Echocardiographic Criteria for Congestive Heart Failure in Korean Patients with Nonvalvular Atrial Fibrillation

The Thromboembolic Predictability of CHA2DS2-VASc Scores Using Different Echocardiographic Criteria for Congestive Heart Failure in Korean Patients with Nonvalvular Atrial Fibrillation

LDL-C/HDL-C is associated with ischaemic stroke in patients with non-valvular atrial fibrillation: a case-control study

LDL-C/HDL-C is Associated With Ischaemic Stroke in Patients With Non-Valvular Atrial Fibrillation: A Case-Control Study

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Heart failure: a weak link in CHA2DS2‐VASc

Cited by 10 publications

References 21 publications

The Thromboembolic Predictability of CHA2DS2-VASc Scores Using Different Echocardiographic Criteria for Congestive Heart Failure in Korean Patients with Nonvalvular Atrial Fibrillation

The Thromboembolic Predictability of CHA2DS2-VASc Scores Using Different Echocardiographic Criteria for Congestive Heart Failure in Korean Patients with Nonvalvular Atrial Fibrillation

LDL-C/HDL-C is associated with ischaemic stroke in patients with non-valvular atrial fibrillation: a case-control study

LDL-C/HDL-C is Associated With Ischaemic Stroke in Patients With Non-Valvular Atrial Fibrillation: A Case-Control Study

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Heart failure: a weak link in CHA₂DS₂‐VASc