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- Publisher Website: 10.1016/j.atherosclerosis.2014.08.026
- Scopus: eid_2-s2.0-84908505528
- PMID: 25463082
- WOS: WOS:000346066600051
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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
Title | 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 |
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Authors | |
Keywords | Adverse cardiovascular events Cardiovascular continuum CHADS2 and CHA2DS2-VASc scores PR prolongation Risk prediction Vascular dysfunction |
Issue Date | 2014 |
Publisher | Elsevier 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? |
Abstract | Objectives: 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 Identifier | http://hdl.handle.net/10722/207444 |
ISSN | 2023 Impact Factor: 4.9 2023 SCImago Journal Rankings: 1.461 |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Chan, YH | - |
dc.contributor.author | Yiu, KH | - |
dc.contributor.author | Lau, GKK | - |
dc.contributor.author | Yiu, YF | - |
dc.contributor.author | Li, SW | - |
dc.contributor.author | Lam, TH | - |
dc.contributor.author | Lau, CP | - |
dc.contributor.author | Siu, CW | - |
dc.contributor.author | Tse, HF | - |
dc.date.accessioned | 2014-12-19T12:55:25Z | - |
dc.date.available | 2014-12-19T12:55:25Z | - |
dc.date.issued | 2014 | - |
dc.identifier.citation | Atherosclerosis, 2014, v. 237 n. 2, p. 504-513 | - |
dc.identifier.issn | 0021-9150 | - |
dc.identifier.uri | http://hdl.handle.net/10722/207444 | - |
dc.description.abstract | Objectives: 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.language | eng | - |
dc.publisher | Elsevier Ireland Ltd. The Journal's web site is located at http://www.elsevier.com/locate/atherosclerosis | - |
dc.relation.ispartof | Atherosclerosis | - |
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.subject | Adverse cardiovascular events | - |
dc.subject | Cardiovascular continuum | - |
dc.subject | CHADS2 and CHA2DS2-VASc scores | - |
dc.subject | PR prolongation | - |
dc.subject | Risk prediction | - |
dc.subject | Vascular dysfunction | - |
dc.title | 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 | - |
dc.type | Article | - |
dc.identifier.email | Chan, YH: chanwill@hku.hk | - |
dc.identifier.email | Yiu, KH: khkyiu@hku.hk | - |
dc.identifier.email | Lau, GKK: gkklau@hku.hk | - |
dc.identifier.email | Lam, TH: hrmrlth@hkucc.hku.hk | - |
dc.identifier.email | Lau, CP: cplau@hku.hk | - |
dc.identifier.email | Tse, HF: hftse@hkucc.hku.hk | - |
dc.identifier.authority | Chan, YH=rp01313 | - |
dc.identifier.authority | Yiu, KH=rp01490 | - |
dc.identifier.authority | Lau, GKK=rp01499 | - |
dc.identifier.authority | Lam, TH=rp00326 | - |
dc.identifier.authority | Tse, HF=rp00428 | - |
dc.identifier.doi | 10.1016/j.atherosclerosis.2014.08.026 | - |
dc.identifier.pmid | 25463082 | - |
dc.identifier.scopus | eid_2-s2.0-84908505528 | - |
dc.identifier.hkuros | 241817 | - |
dc.identifier.volume | 237 | - |
dc.identifier.issue | 2 | - |
dc.identifier.spage | 504 | - |
dc.identifier.epage | 513 | - |
dc.identifier.isi | WOS:000346066600051 | - |
dc.publisher.place | Ireland | - |
dc.identifier.issnl | 0021-9150 | - |