Can CHA2DS2-VASc and HAS-BLED Foresee the Presence of Cerebral Microbleeds, Lacunar and Non-Lacunar Infarcts in Elderly Patients With Atrial Fibrillation? Data From Strat-AF Study

Elisa Bianconi; Giulia Del Freo; Emilia Salvadori; Carmen Barbato; Benedetta Formelli; Francesca Pescini; Giovanni Pracucci; Cristina Sarti; Francesca Cesari; Stefano Chiti; Stefano Diciotti; Anna Maria Gori; Chiara Marzi; Enrico Fainardi; Betti Giusti; Rossella Marcucci; Bruno Bertaccini; Anna Poggesi

doi:10.3389/fneur.2022.883786

Can CHA₂DS₂-VASc and HAS-BLED Foresee the Presence of Cerebral Microbleeds, Lacunar and Non-Lacunar Infarcts in Elderly Patients With Atrial Fibrillation? Data From Strat-AF Study

Front Neurol. 2022 May 13:13:883786. doi: 10.3389/fneur.2022.883786. eCollection 2022.

Authors

Elisa Bianconi¹, Giulia Del Freo¹, Emilia Salvadori², Carmen Barbato^{2

3}, Benedetta Formelli², Francesca Pescini⁴, Giovanni Pracucci², Cristina Sarti^{2

4}, Francesca Cesari⁵, Stefano Chiti⁶, Stefano Diciotti⁷, Anna Maria Gori^{8

9}, Chiara Marzi¹⁰, Enrico Fainardi¹¹, Betti Giusti^{8

9}, Rossella Marcucci^{8

9}, Bruno Bertaccini¹, Anna Poggesi^{2

3

4}

Affiliations

¹ Department of Statistics, Computer Science, Applications ≪ G. Parenti ≫, University of Florence, Florence, Italy.
² NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy.
³ Don Carlo Gnocchi Foundation, Milan, Italy.
⁴ Stroke Unit, Careggi University Hospital, Florence, Italy.
⁵ Central Laboratory, Careggi University Hospital, Florence, Italy.
⁶ Department Health Professions, U.O. Research and Development, Careggi University Hospital, Florence, Italy.
⁷ Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy.
⁸ Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
⁹ Atherothrombotic Diseases Center, Careggi University Hospital, Florence, Italy.
¹⁰ Institute of Applied Physics "Nello Carrara" (IFAC), National Research Council of Italy (CNR), Florence, Italy.
¹¹ Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital, University of Florence, Florence, Italy.

Abstract

Anticoagulants reduce embolic risk in atrial fibrillation (AF), despite increasing hemorrhagic risk. In this context, validity of congestive heart failure, hypertension, age ≥ 75 years, diabetes, stroke, vascular disease, age 65-74 years and sex category (CHA₂DS₂-VASc) and hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly (HAS-BLED) scales, used to respectively evaluate thrombotic and hemorrhagic risks, is incomplete. In patients with AF, brain MRI has led to the increased detection of "asymptomatic" brain changes, particularly those related to small vessel disease, which also represent the pathologic substrate of intracranial hemorrhage, and silent brain infarcts, which are considered risk factors for ischemic stroke. Routine brain MRI in asymptomatic patients with AF is not yet recommended. Our aim was to test predictive ability of risk stratification scales on the presence of cerebral microbleeds, lacunar, and non-lacunar infarcts in 170 elderly patients with AF on oral anticoagulants. Ad hoc developed R algorithms were used to evaluate CHA₂DS₂-VASc and HAS-BLED sensitivity and specificity on the prediction of cerebrovascular lesions: (1) Maintaining original items' weights; (2) augmenting weights' range; (3) adding cognitive, motor, and depressive scores. Accuracy was poor for each outcome considering both scales either in phase 1 or phase 2. Accuracy was never improved by the addition of cognitive scores. The addition of motor and depressive scores to CHA₂DS₂-VASc improved accuracy for non-lacunar infarcts (sensitivity = 0.70, specificity = 0.85), and sensitivity for lacunar-infarcts (sensitivity = 0.74, specificity = 0.61). Our results are a very first step toward the attempt to identify those elderly patients with AF who would benefit most from brain MRI in risk stratification.

Keywords: CHA2DS2-VASc scale; HAS-BLED scale; anticoagulation; atrial fibrillation; brain MRI; cerebral small vessel disease; intracerebral hemorrhage; stroke.