Ischemic Stroke in Non-Gender-Related CHA2DS2-VA Score 0~1 Is Associated With H2FPEF Score Among the Patients With Atrial Fibrillation

Min Kim; Hee Tae Yu; Tae-Hoon Kim; Dae-In Lee; Jae-Sun Uhm; Young Dae Kim; Hyo Suk Nam; Boyoung Joung; Moon-Hyoung Lee; Ji Hoe Heo; Hui-Nam Pak

doi:10.3389/fcvm.2021.791112

Ischemic Stroke in Non-Gender-Related CHA₂DS₂-VA Score 0~1 Is Associated With H₂FPEF Score Among the Patients With Atrial Fibrillation

Front Cardiovasc Med. 2022 Feb 8:8:791112. doi: 10.3389/fcvm.2021.791112. eCollection 2021.

Authors

Affiliations

¹ Division of Cardiology, Chungbuk National University Hospital, Cheongju, South Korea.
² Division of Cardiology, Yonsei University Health System, Seoul, South Korea.
³ Department of Neurology, Yonsei University Health System, Seoul, South Korea.

Abstract

Background: Ischemic strokes (ISs) can appear even in non-gender-related CHA₂DS₂-VA scores 0~1 patients with atrial fibrillation (AF). We explored the determinants associated with IS development among the patients with non-gender-related CHA₂DS₂-VA score 0~1 AF.

Methods and results: In this single-center retrospective registry data for AF catheter ablation (AFCA), we included 1,353 patients with AF (24.7% female, median age 56 years, and paroxysmal AF 72.6%) who had non-gender-related CHA₂DS₂-VA score 0~1, normal left ventricular (LV) systolic function, and available H₂FPEF score. Among those patients, 113 experienced IS despite a non-gender-related CHA₂DS₂-VA score of 0~1. All included patients underwent AFCA, and we evaluated the associated factors with IS in non-gender-related CHA₂DS₂-VA score 0~1 AF. Patients with ISs in this study had a lower estimated glomerular filtration rate (eGFR) (p < 0.001) and LV ejection fraction (LVEF; p = 0.017), larger LA diameter (p < 0.001), reduced LA appendage peak velocity (p < 0.001), and a higher baseline H₂FPEF score (p = 0.018) relative to those without ISs. Age [odds ratio (OR) 1.11 (1.07-1.17), p < 0.001, Model 1] and H₂FPEF score as continuous [OR 1.31 (1.03-1.67), p = 0.028, Model 2] variable were independently associated with ISs by multivariate analysis. Moreover, the eGFR was independently associated with IS at low CHA₂DS₂-VA scores in both Models 1 and 2. AF recurrence was significantly higher in patients with IS (log-rank p < 0.001) but not in those with high H₂FPEF scores (log-rank p = 0.079), respectively.

Conclusions: Among the patients with normal LVEF and non-gender-related CHA₂DS₂-VA score 0~1 AF, the high H₂FPEF score, and increasing age were independently associated with IS development (ClinicalTrials.gov Identifier: NCT02138695).

Keywords: CHA2DS2-VA score; H2FPEF score; atrial fibrillation; atrial myopathy; stroke.

Associated data

ClinicalTrials.gov/NCT02138695