Using the CHADS&lt;sub&gt;2&lt;/sub&gt; and CHA&lt;sub&gt;2&lt;/sub&gt;DS&lt;sub&gt;2&lt;/sub&gt;-VASc Scores for Stroke Risk Prediction as well as the Identification of Stroke Outcomes and Cardiac Complications in Patients with and without Atrial Fibrillation

Lip, Gregory Y.H.

doi:10.1159/000355981

Cited by 12 publications

(9 citation statements)

References 38 publications

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“…A recent study found that the CHADS 2 and CHA 2 DS 2 -VASc scores also were good predictors of 5-year outcomes in non-AF patients with AIS [13]. However, the association of the CHADS 2 and CHA 2 DS 2 -VASc scores with 30-day outcome of AIS has not been previously investigated prospectively [30], [31].…”

Section: Discussionmentioning

confidence: 99%

The Association of CHA2DS2-VASc Score and Blood Biomarkers with Ischemic Stroke Outcomes: The Belgrade Stroke Study

et al. 2014

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BackgroundMany blood biomarkers have a positive association with stroke outcome, but adding blood biomarkers to the National Institutes of Health Stroke Scale (NIHSS) did not significantly improve its discriminatory ability. We investigated the association of the CHA2DS2-VASc score with unfavourable functional outcome (defined as a 30-day modified Rankin Scale [mRS] ≥3) in patients presenting with acute ischemic stroke (AIS), and examined whether the addition of blood biomarkers (troponin I [TnI], fibrinogen, C-reactive protein [CRP]) affects the model discriminatory ability.MethodsWe conducted an observational single-centre study of consecutive patients with AIS. All patients were admitted to hospital within 24 hours from the neurological symptoms onset.ResultsOf 240 patients (mean age 70.0±8.9 years), unfavourable 30-day outcome occurred in 92 (38.3%). Patients with mRS≥3 were older and more likely to have atrial fibrillation or other comorbidities (all p<0.001). They had higher levels of CRP, fibrinogen, TnI and higher CHA2DS2-VASc and CHADS2 scores (all p<0.05). The adjusted CHA2DS2-VASc score had excellent predictive ability for poor stroke outcome (c-statistic 0.982;95%CI,0.964–1.000, p<0.001). Whilst CRP had the highest sensitivity (83.7%), cardiac TnI was the most specific (97.3%) for prediction of poor stroke outcome (cut-off: >0.09µg/L). Compared with each of these biomarkers, CHA2DS2-VASc score had significantly better predictive ability for poor stroke outcome (c-statistic for CRP, Fibrinogen and TnI was 0.853;95%CI,0.802–0.895, 0.848;95%CI,0.796–0.891, and 0.792;95%CI,0.736–0.842, all p<0.001, respectively, versus 0.932;95%CI,0.892–0.960, p<0.001 for the CHA2DS2-VASc, all p for the comparisons<0.01). There was no significant difference in the predictive ability of the CHA2DS2-VASc score vs. combinations of the CHA2DS2-VASc and TnI or TnI, fibrinogen and CRP (z statistic 0.369, p = 0.7119; integrated discrimination index 0.00801 and 0.00172, respectively, both p>0.05).ConclusionsThe CHA2DS2-VASc score alone reliably predicts 30-day unfavourable outcome of stroke. Adding blood biomarkers to the CHA2DS2-VASc score did not significantly increase the predictive ability of the model.

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Section: Discussionmentioning

confidence: 99%

The Association of CHA2DS2-VASc Score and Blood Biomarkers with Ischemic Stroke Outcomes: The Belgrade Stroke Study

et al. 2014

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“…Because of these unique features, incorporating this blood-based biomarker into risk prediction scores that are based on clinical factors only may overcome some of their limitations and improve their precision in identifying patients at high risk for stroke (e.g. CHA 2 DS 2 VASc score) [ 41 ] or predicting poor outcome in TIA (ABCD2 score) [ 42 ] and acute ischaemic stroke (e.g. the SNARL score) [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

The changes in clot microstructure in patients with ischaemic stroke and the effects of therapeutic intervention: a prospective observational study

et al. 2015

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BackgroundStroke is the second largest cause of death worldwide. Hypercoagulability is a key feature in ischaemic stroke due to the development of an abnormally dense clot structure but techniques assessing the mechanics and quality of clot microstructure have limited clinical use. We have previously validated a new haemorheological technique using three parameters to reflect clot microstructure (Fractal Dimension (df)) ex-vivo, real-time clot formation time (TGP) and blood clot strength (elasticity at the gel point (G’GP)). We aimed to evaluate these novel clotting biomarkers in ischaemic stroke and changes of clot structure following therapeutic intervention.MethodsIn a prospective cohort study clot microstructure was compared in ischaemic stroke patients and a control group of healthy volunteers. Further assessment took place at 2–4 hours and at 24 hours after therapeutic intervention in the stroke group to assess the effects of thrombolysis and anti-platelet therapy.Results75 patients (mean age 72.8 years [SD 13.1]; 47 male, 28 female) with ischaemic stroke were recruited. Of the 75 patients, 32 were thrombolysed with t-PA and 43 were loaded with 300 mg aspirin. The following parameters were significantly different between patients with stroke and the 74 healthy subjects: df (1.760 ± .053 versus 1.735 ± 0.048, p = 0.003), TGP (208 ± 67 versus 231 ± 75, p = 0.05), G’GP (0.056 ± 0.017 versus 0.045 ± 0.014, p < 0.0001) and fibrinogen (3.7 ± 0.8 versus 3.2 ± 0.5, p < 0.00001). There was a significant decrease in df (p = 0.02), G’GP (p = 0.01) and fibrinogen (p = 0.01) following the administration of aspirin and for df (p = 0.003) and fibrinogen (p < 0.001) following thrombolysis as compared to baseline values.ConclusionPatients with ischaemic stroke have denser and stronger clot structure as detected by df and G’GP. The effect of thrombolysis on clot microstructure (df) was more prominent than antiplatelet therapy. Further work is needed to assess the clinical and therapeutic implications of these novel biomarkers.

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“…Using pacemakers programmed to log rapid atrial rate, atrial tachyarrhythmia was also found to be an independent predictor of death in the MOde Selection Trial (MOST) study (Glotzer et al, 2003 ). The decision on whether to initiate anticoagulation is clinical, depending on the patient's risks (e.g., as gauged by risk scores such as CHADS 2 , CHA 2 DS 2 -VASc, and HAS-BLED), the duration and burden of AF, and other patient factors (Pisters et al, 2010 ; You et al, 2012 ; Lip, 2013 ).…”

Section: Arrhythmias and Conduction System Disorders Detection By Aecmentioning

confidence: 99%

Electrocardiographic patch devices and contemporary wireless cardiac monitoring

et al. 2015

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Cardiac electrophysiologic derangements often coexist with disorders of the circulatory system. Capturing and diagnosing arrhythmias and conduction system disease may lead to a change in diagnosis, clinical management and patient outcomes. Standard 12-lead electrocardiogram (ECG), Holter monitors and event recorders have served as useful diagnostic tools over the last few decades. However, their shortcomings are only recently being addressed by emerging technologies. With advances in device miniaturization and wireless technologies, and changing consumer expectations, wearable “on-body” ECG patch devices have evolved to meet contemporary needs. These devices are unobtrusive and easy to use, leading to increased device wear time and diagnostic yield. While becoming the standard for detecting arrhythmias and conduction system disorders in the outpatient setting where continuous ECG monitoring in the short to medium term (days to weeks) is indicated, these cardiac devices and related digital mobile health technologies are reshaping the clinician-patient interface with important implications for future healthcare delivery.

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Using the CHADS<sub>2</sub> and CHA<sub>2</sub>DS<sub>2</sub>-VASc Scores for Stroke Risk Prediction as well as the Identification of Stroke Outcomes and Cardiac Complications in Patients with and without Atrial Fibrillation

Cited by 12 publications

References 38 publications

The Association of CHA2DS2-VASc Score and Blood Biomarkers with Ischemic Stroke Outcomes: The Belgrade Stroke Study

The Association of CHA2DS2-VASc Score and Blood Biomarkers with Ischemic Stroke Outcomes: The Belgrade Stroke Study

The changes in clot microstructure in patients with ischaemic stroke and the effects of therapeutic intervention: a prospective observational study

Electrocardiographic patch devices and contemporary wireless cardiac monitoring

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