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Article: The CHADS2 and CHA2DS2-VASc scores predict adverse vascular function, ischemic stroke and cardiovascular death in high-risk patients without atrial fibrillation: Role of incorporating PR prolongation

TitleThe CHADS2 and CHA2DS2-VASc scores predict adverse vascular function, ischemic stroke and cardiovascular death in high-risk patients without atrial fibrillation: Role of incorporating PR prolongation
Authors
Issue Date2014
PublisherElsevier Ireland Ltd. The Journal's web site is located at http://www.elsevier.com/locate/atherosclerosis
Citation
Atherosclerosis, 2014, v. 237 n. 2, p. 504-513 How to Cite?
AbstractObjectives: To investigate whether the CHADS2 and CHA2DS2-VASc scores have clinical utility for prediction of adverse vascular function and vascular dysfunction-mediated incident cardiovascular (CV) events among high-risk patients without atrial fibrillation (AF), and the additional value of incorporating PR prolongation to the scores. Methods: We analyzed 579 high-risk CV outpatients without clinical AF in a prospective cohort for new-onset ischemic stroke, myocardial infarction (MI), congestive heart failure (CHF), and CV death. Brachial flow-mediated dilation (FMD) and nitroglycerin-mediated dilatation (NMD), carotid intima-media thickness (IMT) and pulse wave velocity (PWV) were determined. Results: Baseline CHADS2 score was associated with lower FMD (Pearson r=-0.16, P<0.001) and NMD (r=-0.17, P<0.001), higher carotid IMT (r=0.30, P<0.001) and PWV (r=0.35, P<0.001; similar for CHA2DS2-VASc score: All P<0.05). After follow-up of 63±11 months, 82 patients (14.2%) developed combined CV endpoint. ROC curve analysis showed that both CHADS2 and CHA2DS2-VASc scores were predictors for ischemic stroke (C-Statistic: CHADS2 0.70, P=0.004; CHA2DS2-VASc 0.68, P=0.010), MI (CHADS2 0.63, P=0.030; CHA2DS2-VASc 0.70, P=0.001), and CV death (CHADS2 0.63, P=0.022; CHA2DS2-VASc 0.65, P=0.011). Higher CHADS2 score was associated with reduced event-free survival from combined CV endpoints (log-rank=16.7, P<0.001) with differences potentiated if stratified by CHA2DS2-VASc score (log-rank=29.2, P<0.001). Incorporating PR prolongation, the CHA2DS2-VASc-PR score achieved the highest C-Statistic for CV death prediction (0.70, P<0.001) superior to the CHADS2 score (chi-square: 12.1, P=0.0005). Conclusions: The CHADS2 and CHA2DS2-VASc predict vascular dysfunction and cardiovascular events in high-risk CV patients without clinical AF, with further improved performance incorporating PR prolongation. © 2014 Elsevier Ireland Ltd.
Persistent Identifierhttp://hdl.handle.net/10722/207444
ISSN
2015 Impact Factor: 3.942
2015 SCImago Journal Rankings: 1.819
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorChan, YH-
dc.contributor.authorYiu, KH-
dc.contributor.authorLau, GKK-
dc.contributor.authorYiu, YF-
dc.contributor.authorLi, SW-
dc.contributor.authorLam, TH-
dc.contributor.authorLau, CP-
dc.contributor.authorSiu, CW-
dc.contributor.authorTse, HF-
dc.date.accessioned2014-12-19T12:55:25Z-
dc.date.available2014-12-19T12:55:25Z-
dc.date.issued2014-
dc.identifier.citationAtherosclerosis, 2014, v. 237 n. 2, p. 504-513-
dc.identifier.issn0021-9150-
dc.identifier.urihttp://hdl.handle.net/10722/207444-
dc.description.abstractObjectives: To investigate whether the CHADS2 and CHA2DS2-VASc scores have clinical utility for prediction of adverse vascular function and vascular dysfunction-mediated incident cardiovascular (CV) events among high-risk patients without atrial fibrillation (AF), and the additional value of incorporating PR prolongation to the scores. Methods: We analyzed 579 high-risk CV outpatients without clinical AF in a prospective cohort for new-onset ischemic stroke, myocardial infarction (MI), congestive heart failure (CHF), and CV death. Brachial flow-mediated dilation (FMD) and nitroglycerin-mediated dilatation (NMD), carotid intima-media thickness (IMT) and pulse wave velocity (PWV) were determined. Results: Baseline CHADS2 score was associated with lower FMD (Pearson r=-0.16, P<0.001) and NMD (r=-0.17, P<0.001), higher carotid IMT (r=0.30, P<0.001) and PWV (r=0.35, P<0.001; similar for CHA2DS2-VASc score: All P<0.05). After follow-up of 63±11 months, 82 patients (14.2%) developed combined CV endpoint. ROC curve analysis showed that both CHADS2 and CHA2DS2-VASc scores were predictors for ischemic stroke (C-Statistic: CHADS2 0.70, P=0.004; CHA2DS2-VASc 0.68, P=0.010), MI (CHADS2 0.63, P=0.030; CHA2DS2-VASc 0.70, P=0.001), and CV death (CHADS2 0.63, P=0.022; CHA2DS2-VASc 0.65, P=0.011). Higher CHADS2 score was associated with reduced event-free survival from combined CV endpoints (log-rank=16.7, P<0.001) with differences potentiated if stratified by CHA2DS2-VASc score (log-rank=29.2, P<0.001). Incorporating PR prolongation, the CHA2DS2-VASc-PR score achieved the highest C-Statistic for CV death prediction (0.70, P<0.001) superior to the CHADS2 score (chi-square: 12.1, P=0.0005). Conclusions: The CHADS2 and CHA2DS2-VASc predict vascular dysfunction and cardiovascular events in high-risk CV patients without clinical AF, with further improved performance incorporating PR prolongation. © 2014 Elsevier Ireland Ltd.-
dc.languageeng-
dc.publisherElsevier Ireland Ltd. The Journal's web site is located at http://www.elsevier.com/locate/atherosclerosis-
dc.relation.ispartofAtherosclerosis-
dc.rights© <year>. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/-
dc.titleThe CHADS2 and CHA2DS2-VASc scores predict adverse vascular function, ischemic stroke and cardiovascular death in high-risk patients without atrial fibrillation: Role of incorporating PR prolongation-
dc.typeArticle-
dc.identifier.emailChan, YH: chanwill@hku.hk-
dc.identifier.emailYiu, KH: khkyiu@hku.hk-
dc.identifier.emailLau, GKK: gkklau@hku.hk-
dc.identifier.emailLam, TH: hrmrlth@hkucc.hku.hk-
dc.identifier.emailLau, CP: cplau@hku.hk-
dc.identifier.emailTse, HF: hftse@hkucc.hku.hk-
dc.identifier.authorityChan, YH=rp01313-
dc.identifier.authorityYiu, KH=rp01490-
dc.identifier.authorityLau, GKK=rp01499-
dc.identifier.authorityLam, TH=rp00326-
dc.identifier.authorityTse, HF=rp00428-
dc.identifier.doi10.1016/j.atherosclerosis.2014.08.026-
dc.identifier.pmid25463082-
dc.identifier.scopuseid_2-s2.0-84908505528-
dc.identifier.hkuros241817-
dc.identifier.volume237-
dc.identifier.issue2-
dc.identifier.spage504-
dc.identifier.epage513-
dc.identifier.isiWOS:000346066600051-
dc.publisher.placeIreland-

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