title: Association of CHADS2, CHA2DS2-VASc, and R2CHADS2 scores with left atrial dysfunction in patients with coronary heart disease (from the Heart and Soul study).
abstract: The predictive ability of the CHADS2 index to stratify stroke risk may be mechanistically linked to severity of left atrial (LA) dysfunction. This study investigated the association between the CHADS2 score and LA function. We performed resting transthoracic echocardiography in 970 patients with stable coronary heart disease and normal ejection fraction and calculated baseline LA functional index (LAFI) using a validated formula: (LA emptying fraction×left ventricular outflow tract velocity time integral)/LA end-systolic volume indexed to body surface area. We performed regression analyses to evaluate the association between risk scores and LAFI. Among 970 subjects, mean CHADS2 was 1.7±1.2. Mean LAFI decreased across tertiles of CHADS2 (42.8±18.1, 37.8±19.1, 36.7±19.4, p<0.001). After adjustment for age, sex, race, systolic blood pressure, hyperlipidemia, myocardial infarction, revascularization, body mass index, smoking, and alcohol use, high CHADS2 remained associated with the lowest quartile of LAFI (odds ratio 2.34, p=0.001). In multivariable analysis of component co-morbidities, heart failure, age, and creatinine clearance<60 ml/min were strongly associated with LA dysfunction. For every point increase in CHADS2, the LAFI decreased by 4.0%. Secondary analyses using CHA2DS2-VASc and R2CHADS2 scores replicated these results. Findings were consistent when excluding patients with baseline atrial fibrillation. In conclusion, CHADS2, CHA2DS2-VASc, and R2CHADS2 scores are associated with LA dysfunction, even in patients without baseline atrial fibrillation. These findings merit further study to determine the role of LA dysfunction in cardioembolic stroke and the value of LAFI for risk stratification.
authors: Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California; Veterans Affairs Medical Center, Palo Alto, California.
authors: Farnaz
authors: F
authors: Azarbal
authors: Department of Medicine, University of California, San Francisco, California; Veterans Affairs Medical Center, San Francisco, California.
authors: Christine C
authors: CC
authors: Welles
authors: Doris Duke Clinical Research Fellowship Program, University of California, San Francisco, California; School of Medicine, University of California, Irvine, California.
authors: Jonathan M
authors: JM
authors: Wong
authors: Department of Medicine, University of California, San Francisco, California; Veterans Affairs Medical Center, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California.
authors: Mary A
authors: MA
authors: Whooley
authors: Veterans Affairs Medical Center, San Francisco, California; Division of Cardiology, Department of Medicine, University of California, San Francisco, California.
authors: Nelson B
authors: NB
authors: Schiller
authors: Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California; Veterans Affairs Medical Center, Palo Alto, California. Electronic address: mintu@stanford.edu.
authors: Mintu P
authors: MP
authors: Turakhia
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology; D016279:Atrial Function, Left / Q000502:physiology*; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D004452:Echocardiography / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D020257:Ventricular Remodeling