Association of CHADS2, CHA2DS2-VASc, and R2CHADS2 Scores With Left Atrial Dysfunction in Patients With Coronary Heart Disease (From the Heart and Soul Study)

Study Questions:

Is there a relationship between risk scores for future stroke and left atrial (LA) function?

Methods:

This study examined 970 patients with stable coronary heart disease and normal left ventricular function, and evaluated the relationship between LA functional index (LAFI) and risk scores for stroke established in patients with atrial fibrillation. Risk scores evaluated included the CHADS2, CHA2DS2-VASc, and R2CHADS2 indices. Subgroup analyses were performed in patients without baseline atrial fibrillation.

Results:

Increased tertiles of CHADS2, CHA2DS2-VASc, and R2CHADS2 indices were associated with LAFI. Comparing patients by tertile of the CHADS2 score (0-1 vs. 2-3 vs. 4-6), there were significant decreases in LAFI (43 ± 18 vs. 38 ± 19 vs. 37 ± 19, p < 0.001); similar findings were observed by tertiles of the CHA2DS2-VASc (p < 0.001), and R2CHADS2 (p < 0.001) indices. On multivariable analyses, higher tertiles of these scores and higher absolute scores were associated with a significant decrease in LAFI (p < 0.05 for each). In subgroup analyses of patients without baseline atrial fibrillation, the independent relationships between increased risk score and decreased LAFI were significant using each of the risk scores.

Conclusions:

In patients with stable coronary heart disease and normal left ventricular function, increased CHADS2, CHA2DS2-VASc, and R2CHADS2 risk scores were observed in patients with reduced LA function.

Perspective:

LA dysfunction is associated with higher CHADS2, CHA2DS2-VASc, and R2CHADS2 risk scores, even after excluding patients with baseline atrial fibrillation. These findings suggest that risk factors for stroke in patients with atrial fibrillation may be similar to risk factors for LA dysfunction. The role of LA function in identifying patients at increased risk of stroke in patients with and without atrial fibrillation needs to be further elucidated.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Atrial Function, Left, Coronary Artery Disease, Stroke, Ventricular Function, Left, Heart Failure, Risk Factors


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