title: CHADS(2) and CHA(2)DS(2)VASc scores as predictors of cardioembolic sources in secondary stroke prevention.
abstract: OBJECTIVE
  Cardioembolism is one of the most common causes of ischemic stroke, with an estimated prevalence of 20-30%, and correct diagnosis is essential given the therapeutic implications. Although stroke risk scores (CHADS2 and more recently CHA2DS2-VASc) have been validated in heterogeneous populations of patients with atrial fibrillation, their accuracy has not been ascertained for secondary stroke prevention. We set out to assess the sensitivity and specificity of the CHADS2 and CHA2DS2-VASc stroke risk scores as predictors of cardioembolic sources, documented by transesophageal echocardiography (TEE) in a population with ischemic stroke.
  
  
  METHODS
  The CHADS2 and CHA2DS2-VASc scores were applied to all patients admitted to the stroke unit/neurology ward of a Portuguese tertiary hospital with atrial fibrillation (diagnosed previously or during or after admission) who underwent TEE between January and August 2011. The presence of a cardioembolic source was defined as the observation by TEE of spontaneous echo contrast in the left atrium and atrial appendage or thrombi in the left cardiac chambers.
  
  
  RESULTS
  We studied 94 patients, 66.0% male, mean age 64.4 years (standard deviation 14.2). A cardioembolic source was detected in 20 patients. ROC curve analysis identified as predictors of cardioembolic source CHADS2 score ≥4 (sensitivity of 75.0%, specificity of 66.0%, p=0.014) and CHA2DS2-VASc score ≥5 (sensitivity of 83.3%, specificity of 58.0%, p=0.009).
  
  
  CONCLUSIONS
  Both scores showed acceptable sensitivity as predictors of embolic risk in the context of secondary prevention of cardioembolic stroke. The CHA2DS2-VASc score has higher sensitivity than CHADS2 but lower specificity.
authors.affiliation: Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal.
authors.forename: Tiago
authors.initials: T
authors.lastname: Sá
authors.forename: João
authors.initials: J
authors.lastname: Sargento-Freitas
authors.forename: Vítor
authors.initials: V
authors.lastname: Pinheiro
authors.forename: Rui
authors.initials: R
authors.lastname: Martins
authors.forename: Rogério
authors.initials: R
authors.lastname: Teixeira
authors.forename: Fernando
authors.initials: F
authors.lastname: Silva
authors.forename: Nuno
authors.initials: N
authors.lastname: Mendonça
authors.forename: Gustavo
authors.initials: G
authors.lastname: Cordeiro
authors.forename: Lino
authors.initials: L
authors.lastname: Gonçalves
authors.forename: Luís A
authors.initials: LA
authors.lastname: Providência
authors.forename: António
authors.initials: A
authors.lastname: Freire-Gonçalves
authors.forename: Luís
authors.initials: L
authors.lastname: Cunha
mesh_terms: D000368:Aged; D017548:Echocardiography, Transesophageal; D004617:Embolism / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D006331:Heart Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018570:Risk Assessment; D055502:Secondary Prevention; D020521:Stroke / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*