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Benz AP, Healey JS, Chin A, et al. Stroke risk prediction in patients with atrial fibrillation with and without rheumatic heart disease. Cardiovasc Res. 2022;118(1):295-304doi: 10.1093/cvr/cvaa344.
Benz, A. P., Healey, J. S., Chin, A., Commerford, P., Marsden, T., Karthikeyan, G., McIntyre, W. F., Wong, J. A., Damasceno, A., Hohnloser, S. H., Oldgren, J., Wallentin, L., Ezekowitz, M. D., Eikelboom, J. W., Yusuf, S., & Connolly, S. J. (2022). Stroke risk prediction in patients with atrial fibrillation with and without rheumatic heart disease. Cardiovascular research, 118(1), 295-304. https://doi.org/10.1093/cvr/cvaa344
Benz, Alexander P, et al. "Stroke risk prediction in patients with atrial fibrillation with and without rheumatic heart disease." Cardiovascular research vol. 118,1 (2022): 295-304. doi: https://doi.org/10.1093/cvr/cvaa344
Benz AP, Healey JS, Chin A, Commerford P, Marsden T, Karthikeyan G, McIntyre WF, Wong JA, Damasceno A, Hohnloser SH, Oldgren J, Wallentin L, Ezekowitz MD, Eikelboom JW, Yusuf S, Connolly SJ. Stroke risk prediction in patients with atrial fibrillation with and without rheumatic heart disease. Cardiovasc Res. 2022 Jan 07;118(1):295-304. doi: 10.1093/cvr/cvaa344. PMID: 33386845.
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Cardiovasc Res. 2022 Jan 07;118(1):295-304. doi: 10.1093/cvr/cvaa344.

Stroke risk prediction in patients with atrial fibrillation with and without rheumatic heart disease.

Cardiovascular research

Alexander P Benz, Jeff S Healey, Ashley Chin, Patrick Commerford, Tamara Marsden, Ganesan Karthikeyan, William F McIntyre, Jorge A Wong, Albertino Damasceno, Stefan H Hohnloser, Jonas Oldgren, Lars Wallentin, Michael D Ezekowitz, John W Eikelboom, Salim Yusuf, Stuart J Connolly

Affiliations

  1. Division of Cardiology, Population Health Research Institute, McMaster University, 237 Barton St. E. Hamilton, ON L8L 2X2, Canada.
  2. Department of Medicine, The Cardiac Clinic, Groote Schuur Hospital, University of Caape Town, Cape Town, South Africa.
  3. Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
  4. Department of Medicine, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
  5. Department of Cardiology, Division of Clinical Electrophysiology, Johann Wolfgang Goethe University, Frankfurt, Germany.
  6. Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
  7. Department of Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Lankenau and Bryn Mawr Hospitals, Philadelphia, PA, USA.

PMID: 33386845 DOI: 10.1093/cvr/cvaa344

Abstract

AIMS: Patients with atrial fibrillation (AF) and rheumatic heart disease (RHD), especially mitral stenosis, are assumed to be at high risk of stroke, irrespective of other factors. We aimed to re-evaluate stroke risk factors in a contemporary cohort of AF patients.

METHODS AND RESULTS: We analysed data of 15 400 AF patients presenting to an emergency department and who were enrolled in the global RE-LY AF registry, representing 47 countries from all inhabited continents. Follow-up occurred at 1 year after enrolment. A total of 1788 (11.6%) patients had RHD. These patients were younger (51.4±15.7 vs. 67.8±13.6 years), more likely to be female (66.2% vs. 44.7%) and had a lower mean CHA2DS2-VASc score (2.1±1.7 vs. 3.7±2.2) as compared to patients without RHD (all P<0.001). Significant mitral stenosis (average mean transmitral gradient 11.5±6.5 mmHg) was the predominant valve lesion in those with RHD (59.6%). Patients with RHD had a higher baseline rate of anticoagulation use (60.4% vs. 45.2%, P<0.001). Unadjusted stroke rates at 1 year were 2.8% and 4.1% for patients with and without RHD, respectively. The performance of the CHA2DS2-VASc score was modest in both groups [stroke at 1 year, c-statistics 0.69, 95% confidence interval (CI) 0.60-0.78 and 0.63, 95% CI 0.61-0.66, respectively]. In the overall cohort, advanced age, female sex, prior stroke, tobacco use, and non-use of anticoagulation were predictors for stroke (all P<0.05). Mitral stenosis was not associated with stroke risk (adjusted odds ratio 1.07, 95% CI 0.67-1.72, P=0.764).

CONCLUSION: The performance of the CHA2DS2-VASc score was modest in AF patients both with and without RHD. In this cohort, moderate-to-severe mitral stenosis was not an independent risk factor for stroke.

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: [email protected].

Keywords: Atrial fibrillation; Mitral stenosis; Rheumatic heart disease; Stroke; Valvular

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Grant support