Nonvalvular Atrial Fibrillation and CHA2DS2-VASc Prediction | Journal Scan

Study Questions:

Is the CHA2DS2-VASc score a valid predictor of stroke risk in patients with atrial fibrillation (AF) and aortic stenosis (AS), aortic regurgitation (AR), or mitral regurgitation (MR)?

Methods:

This was a single-center retrospective analysis of 8,053 patients (mean age 71 years) who had AF without mitral stenosis or a prosthetic valve. Moderate to severe AS, AR, or MR was present in 1,202 of the 8,053 patients. The CHA2DS2-VASc score was calculated for each patient and correlated with strokes and thromboembolic events (TEs) during a mean follow-up of 29 months.

Results:

AS, AR, or MR were not independent predictors of stroke/TEs. The risk of a stroke/TE was 39% higher in patients who had these types of valve disease, but this was attributable to higher CHA2DS2-VASc scores. The independent predictors of stroke/TEs were age and CHA2DS2-VASc. The annual stroke/TE risk was approximately 1% when the CHA2DS2-VASc score was 0-1 and approximately 10% when the CHA2DS2-VASc score was ≥6, both in patients with and without AS, AR, or MR.

Conclusions:

AS, AR, and MR are associated with a higher risk of stroke and TE events among patients who have AF. This is attributable to higher CHA2DS2-VASc scores.

Perspective:

The confusing title is explained by the fact that the European Society of Cardiology guidelines define ‘valvular AF’ as AF in the setting of mitral stenosis or a prosthetic valve. If one presumes that all patients have either valvular or nonvalvular AF, the guidelines definition forces one to classify AF in the setting of AS, AR, or MR as ‘nonvalvular AF.’

Clinical Topics: Arrhythmias and Clinical EP, Valvular Heart Disease, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Mitral Regurgitation

Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Aortic Valve Stenosis, Aortic Valve Insufficiency, Follow-Up Studies, Heart Valve Diseases, Mitral Valve Insufficiency, Mitral Valve Stenosis, Retrospective Studies, Risk, Stroke, Thromboembolism


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