Stroke mechanism in patients with non-valvular atrial fibrillation according to the CHADS 2 and CHA 2DS 2-VASc scores

M. J. Cha, Y. D. Kim, H. S. Nam, J. Kim, D. H. Lee, Jihoe Heo

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Background and purpose: The CHADS 2 and CHA 2DS 2-VASc scores are useful to stratify embolic risks in patients with non-valvular atrial fibrillation (NVAF) and to identify patients eligible for anticoagulation. Although the risk of stoke increases in patients with higher CHADS 2 or CHA 2DS 2-VASc scores, it is uncertain why the stroke rate increases in them. Concomitant potential cardiac sources of embolism (PCSE) may be more frequent in patients with higher CHADS 2 or CHA 2DS 2-VASc scores because stroke risks increase when concomitant PCSE is present in Atrial fibrillation (AF). On the other hand, atherothrombosis may be the cause when considering that most components of the CHADS 2 and CHA 2DS 2-VASc scores are risk factors for atherosclerosis. Methods: Amongst 5493 stroke patients who were prospectively registered with the stroke registry for 11years, 860 consecutive patients with NVAF were included for this study. We investigated the mechanisms of stroke according to the CHADS 2/CHA 2DS 2-VASc score in stroke patients with NVAF. Results: Amongst 860 patients, concomitant PCSE were found in 334 patients (38.8%). The number of PCSE increased as the CHADS 2/CHA 2DS 2-VASc score increased (P<0.001). Of individual PCSE, akinetic left ventricular segment, hypokinetic left ventricular segment and myocardial infarction <4weeks were associated with the CHADS 2/CHA 2DS 2-VASc score. The presence of possible atherothrombotic mechanism, in addition to AF, was suggested in 27.3%. The proportion of patients with concomitant presence of possible atherothrombosis was increased as the CHADS 2/CHA 2DS 2-VASc score increased (P<0.001). Conclusions: Increased frequency of concomitant PCSE and that of the atherothrombotic mechanism may explain the high risk of stroke in patients with higher CHADS 2/CHA 2DS 2-VASc score.

Original languageEnglish
Pages (from-to)473-479
Number of pages7
JournalEuropean Journal of Neurology
Volume19
Issue number3
DOIs
Publication statusPublished - 2012 Mar 1

Fingerprint

Atrial Fibrillation
Stroke
Embolism
Registries
Atherosclerosis
Myocardial Infarction

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

Cite this

Cha, M. J. ; Kim, Y. D. ; Nam, H. S. ; Kim, J. ; Lee, D. H. ; Heo, Jihoe. / Stroke mechanism in patients with non-valvular atrial fibrillation according to the CHADS 2 and CHA 2DS 2-VASc scores. In: European Journal of Neurology. 2012 ; Vol. 19, No. 3. pp. 473-479.
@article{c1757a9d532142748de948e2274d1bb4,
title = "Stroke mechanism in patients with non-valvular atrial fibrillation according to the CHADS 2 and CHA 2DS 2-VASc scores",
abstract = "Background and purpose: The CHADS 2 and CHA 2DS 2-VASc scores are useful to stratify embolic risks in patients with non-valvular atrial fibrillation (NVAF) and to identify patients eligible for anticoagulation. Although the risk of stoke increases in patients with higher CHADS 2 or CHA 2DS 2-VASc scores, it is uncertain why the stroke rate increases in them. Concomitant potential cardiac sources of embolism (PCSE) may be more frequent in patients with higher CHADS 2 or CHA 2DS 2-VASc scores because stroke risks increase when concomitant PCSE is present in Atrial fibrillation (AF). On the other hand, atherothrombosis may be the cause when considering that most components of the CHADS 2 and CHA 2DS 2-VASc scores are risk factors for atherosclerosis. Methods: Amongst 5493 stroke patients who were prospectively registered with the stroke registry for 11years, 860 consecutive patients with NVAF were included for this study. We investigated the mechanisms of stroke according to the CHADS 2/CHA 2DS 2-VASc score in stroke patients with NVAF. Results: Amongst 860 patients, concomitant PCSE were found in 334 patients (38.8{\%}). The number of PCSE increased as the CHADS 2/CHA 2DS 2-VASc score increased (P<0.001). Of individual PCSE, akinetic left ventricular segment, hypokinetic left ventricular segment and myocardial infarction <4weeks were associated with the CHADS 2/CHA 2DS 2-VASc score. The presence of possible atherothrombotic mechanism, in addition to AF, was suggested in 27.3{\%}. The proportion of patients with concomitant presence of possible atherothrombosis was increased as the CHADS 2/CHA 2DS 2-VASc score increased (P<0.001). Conclusions: Increased frequency of concomitant PCSE and that of the atherothrombotic mechanism may explain the high risk of stroke in patients with higher CHADS 2/CHA 2DS 2-VASc score.",
author = "Cha, {M. J.} and Kim, {Y. D.} and Nam, {H. S.} and J. Kim and Lee, {D. H.} and Jihoe Heo",
year = "2012",
month = "3",
day = "1",
doi = "10.1111/j.1468-1331.2011.03547.x",
language = "English",
volume = "19",
pages = "473--479",
journal = "European Journal of Neurology",
issn = "1351-5101",
publisher = "Wiley-Blackwell",
number = "3",

}

Stroke mechanism in patients with non-valvular atrial fibrillation according to the CHADS 2 and CHA 2DS 2-VASc scores. / Cha, M. J.; Kim, Y. D.; Nam, H. S.; Kim, J.; Lee, D. H.; Heo, Jihoe.

In: European Journal of Neurology, Vol. 19, No. 3, 01.03.2012, p. 473-479.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Stroke mechanism in patients with non-valvular atrial fibrillation according to the CHADS 2 and CHA 2DS 2-VASc scores

AU - Cha, M. J.

AU - Kim, Y. D.

AU - Nam, H. S.

AU - Kim, J.

AU - Lee, D. H.

AU - Heo, Jihoe

PY - 2012/3/1

Y1 - 2012/3/1

N2 - Background and purpose: The CHADS 2 and CHA 2DS 2-VASc scores are useful to stratify embolic risks in patients with non-valvular atrial fibrillation (NVAF) and to identify patients eligible for anticoagulation. Although the risk of stoke increases in patients with higher CHADS 2 or CHA 2DS 2-VASc scores, it is uncertain why the stroke rate increases in them. Concomitant potential cardiac sources of embolism (PCSE) may be more frequent in patients with higher CHADS 2 or CHA 2DS 2-VASc scores because stroke risks increase when concomitant PCSE is present in Atrial fibrillation (AF). On the other hand, atherothrombosis may be the cause when considering that most components of the CHADS 2 and CHA 2DS 2-VASc scores are risk factors for atherosclerosis. Methods: Amongst 5493 stroke patients who were prospectively registered with the stroke registry for 11years, 860 consecutive patients with NVAF were included for this study. We investigated the mechanisms of stroke according to the CHADS 2/CHA 2DS 2-VASc score in stroke patients with NVAF. Results: Amongst 860 patients, concomitant PCSE were found in 334 patients (38.8%). The number of PCSE increased as the CHADS 2/CHA 2DS 2-VASc score increased (P<0.001). Of individual PCSE, akinetic left ventricular segment, hypokinetic left ventricular segment and myocardial infarction <4weeks were associated with the CHADS 2/CHA 2DS 2-VASc score. The presence of possible atherothrombotic mechanism, in addition to AF, was suggested in 27.3%. The proportion of patients with concomitant presence of possible atherothrombosis was increased as the CHADS 2/CHA 2DS 2-VASc score increased (P<0.001). Conclusions: Increased frequency of concomitant PCSE and that of the atherothrombotic mechanism may explain the high risk of stroke in patients with higher CHADS 2/CHA 2DS 2-VASc score.

AB - Background and purpose: The CHADS 2 and CHA 2DS 2-VASc scores are useful to stratify embolic risks in patients with non-valvular atrial fibrillation (NVAF) and to identify patients eligible for anticoagulation. Although the risk of stoke increases in patients with higher CHADS 2 or CHA 2DS 2-VASc scores, it is uncertain why the stroke rate increases in them. Concomitant potential cardiac sources of embolism (PCSE) may be more frequent in patients with higher CHADS 2 or CHA 2DS 2-VASc scores because stroke risks increase when concomitant PCSE is present in Atrial fibrillation (AF). On the other hand, atherothrombosis may be the cause when considering that most components of the CHADS 2 and CHA 2DS 2-VASc scores are risk factors for atherosclerosis. Methods: Amongst 5493 stroke patients who were prospectively registered with the stroke registry for 11years, 860 consecutive patients with NVAF were included for this study. We investigated the mechanisms of stroke according to the CHADS 2/CHA 2DS 2-VASc score in stroke patients with NVAF. Results: Amongst 860 patients, concomitant PCSE were found in 334 patients (38.8%). The number of PCSE increased as the CHADS 2/CHA 2DS 2-VASc score increased (P<0.001). Of individual PCSE, akinetic left ventricular segment, hypokinetic left ventricular segment and myocardial infarction <4weeks were associated with the CHADS 2/CHA 2DS 2-VASc score. The presence of possible atherothrombotic mechanism, in addition to AF, was suggested in 27.3%. The proportion of patients with concomitant presence of possible atherothrombosis was increased as the CHADS 2/CHA 2DS 2-VASc score increased (P<0.001). Conclusions: Increased frequency of concomitant PCSE and that of the atherothrombotic mechanism may explain the high risk of stroke in patients with higher CHADS 2/CHA 2DS 2-VASc score.

UR - http://www.scopus.com/inward/record.url?scp=84857050998&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84857050998&partnerID=8YFLogxK

U2 - 10.1111/j.1468-1331.2011.03547.x

DO - 10.1111/j.1468-1331.2011.03547.x

M3 - Article

C2 - 21972975

AN - SCOPUS:84857050998

VL - 19

SP - 473

EP - 479

JO - European Journal of Neurology

JF - European Journal of Neurology

SN - 1351-5101

IS - 3

ER -