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
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 pr...
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| Veröffentlicht in: | Atherosclerosis 2014-12, Vol.237 (2), p.504-513 |
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| creator | Chan, Yap-Hang Yiu, Kai-Hang Lau, Kui-Kai Yiu, Yuen-Fung Li, Sheung-Wai Lam, Tai-Hing Lau, Chu-Pak Siu, Chung-Wah Tse, Hung-Fat |
| description | 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.
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.
Baseline CHADS2 score was associated with lower FMD (Pearson r = −0.16, P |
| doi_str_mv | 10.1016/j.atherosclerosis.2014.08.026 |
| format | Article |
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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.
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).
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.
•CHADS2/CHA2DS2-VASc predict atherosclerosis and CV events in patients without AF.•Incorporating PR prolongation improves the risk prediction.]]></description><identifier>ISSN: 0021-9150</identifier><identifier>EISSN: 1879-1484</identifier><identifier>DOI: 10.1016/j.atherosclerosis.2014.08.026</identifier><identifier>PMID: 25463082</identifier><language>eng</language><publisher>Ireland: Elsevier Ireland Ltd</publisher><subject>Adverse cardiovascular events ; Aged ; Atrial Fibrillation - physiopathology ; Body Mass Index ; Cardiovascular continuum ; Cardiovascular Diseases - diagnosis ; Cardiovascular Diseases - physiopathology ; Carotid Intima-Media Thickness ; CHADS2 and CHA2DS2-VASc scores ; Dilatation ; Electrocardiography ; Female ; Follow-Up Studies ; Health Status Indicators ; Heart Failure - physiopathology ; Humans ; Male ; Middle Aged ; Myocardial Ischemia - pathology ; Nitroglycerin - chemistry ; PR prolongation ; Proportional Hazards Models ; Prospective Studies ; Pulse Wave Analysis ; Risk Assessment ; Risk Factors ; Risk prediction ; ROC Curve ; Sex Factors ; Tomography, Emission-Computed, Single-Photon ; Vascular dysfunction</subject><ispartof>Atherosclerosis, 2014-12, Vol.237 (2), p.504-513</ispartof><rights>2014 Elsevier Ireland Ltd</rights><rights>Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c370t-ab787cd26cadb76106b581893e8496c99906011bec9bbb4a42734557525b62693</citedby><cites>FETCH-LOGICAL-c370t-ab787cd26cadb76106b581893e8496c99906011bec9bbb4a42734557525b62693</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.atherosclerosis.2014.08.026$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,45974</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25463082$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chan, Yap-Hang</creatorcontrib><creatorcontrib>Yiu, Kai-Hang</creatorcontrib><creatorcontrib>Lau, Kui-Kai</creatorcontrib><creatorcontrib>Yiu, Yuen-Fung</creatorcontrib><creatorcontrib>Li, Sheung-Wai</creatorcontrib><creatorcontrib>Lam, Tai-Hing</creatorcontrib><creatorcontrib>Lau, Chu-Pak</creatorcontrib><creatorcontrib>Siu, Chung-Wah</creatorcontrib><creatorcontrib>Tse, Hung-Fat</creatorcontrib><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</title><title>Atherosclerosis</title><addtitle>Atherosclerosis</addtitle><description><![CDATA[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.
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.
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).
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.
•CHADS2/CHA2DS2-VASc predict atherosclerosis and CV events in patients without AF.•Incorporating PR prolongation improves the risk prediction.]]></description><subject>Adverse cardiovascular events</subject><subject>Aged</subject><subject>Atrial Fibrillation - physiopathology</subject><subject>Body Mass Index</subject><subject>Cardiovascular continuum</subject><subject>Cardiovascular Diseases - diagnosis</subject><subject>Cardiovascular Diseases - physiopathology</subject><subject>Carotid Intima-Media Thickness</subject><subject>CHADS2 and CHA2DS2-VASc scores</subject><subject>Dilatation</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Health Status Indicators</subject><subject>Heart Failure - physiopathology</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardial Ischemia - pathology</subject><subject>Nitroglycerin - chemistry</subject><subject>PR prolongation</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Pulse Wave Analysis</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Risk prediction</subject><subject>ROC Curve</subject><subject>Sex Factors</subject><subject>Tomography, Emission-Computed, Single-Photon</subject><subject>Vascular dysfunction</subject><issn>0021-9150</issn><issn>1879-1484</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNUc1u1DAQjhCIbguvgHxB4kDC2EnsBInDaiktUiVQW7hatjO78TYbL7aziCfktXC6pQdOXOyR9f2Nvyx7TaGgQPm7baFij94FM8ynDQUDWhXQFMD4k2xBG9HmtGqqp9kCgNG8pTWcZKchbAGgErR5np2wuuIlNGyR_b7tkawulx9vGFFjN48szfn35Y0hwTiPgew9dtZEoroD-oDkoIKZBuXJehpNtG58S2wwPe5sokTv7vBeyijfWfcI7jAFJ3Ykvd30ubfhjuxVtDjGQH7a2LspOURv1UDWVns7DGrWfk-u3YDErRM1xdk7n57HDfl6nXK5wY2be9iL7NlaDQFfPtxn2bdP57ery_zqy8Xn1fIqN6WAmCstGmE6xo3qtOAUuK4b2rQlNlXLTdu2wIFSjabVWleqYqKs6lrUrNac8bY8y94cdZP5jwlDlLu0O6awI7opSMrLGkAIDgn64Qg1qafgcS333u6U_yUpyLlLuZX_dCnnLiU0MnWZ-K8erCa9w-6R_be8BLg4AjAtfLDoZTDpP01qy6OJsnP2P63-AK3XvRM</recordid><startdate>201412</startdate><enddate>201412</enddate><creator>Chan, Yap-Hang</creator><creator>Yiu, Kai-Hang</creator><creator>Lau, Kui-Kai</creator><creator>Yiu, Yuen-Fung</creator><creator>Li, Sheung-Wai</creator><creator>Lam, Tai-Hing</creator><creator>Lau, Chu-Pak</creator><creator>Siu, Chung-Wah</creator><creator>Tse, Hung-Fat</creator><general>Elsevier Ireland Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201412</creationdate><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</title><author>Chan, Yap-Hang ; Yiu, Kai-Hang ; Lau, Kui-Kai ; Yiu, Yuen-Fung ; Li, Sheung-Wai ; Lam, Tai-Hing ; Lau, Chu-Pak ; Siu, Chung-Wah ; Tse, Hung-Fat</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c370t-ab787cd26cadb76106b581893e8496c99906011bec9bbb4a42734557525b62693</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adverse cardiovascular events</topic><topic>Aged</topic><topic>Atrial Fibrillation - physiopathology</topic><topic>Body Mass Index</topic><topic>Cardiovascular continuum</topic><topic>Cardiovascular Diseases - diagnosis</topic><topic>Cardiovascular Diseases - physiopathology</topic><topic>Carotid Intima-Media Thickness</topic><topic>CHADS2 and CHA2DS2-VASc scores</topic><topic>Dilatation</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Health Status Indicators</topic><topic>Heart Failure - physiopathology</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Myocardial Ischemia - pathology</topic><topic>Nitroglycerin - chemistry</topic><topic>PR prolongation</topic><topic>Proportional Hazards Models</topic><topic>Prospective Studies</topic><topic>Pulse Wave Analysis</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Risk prediction</topic><topic>ROC Curve</topic><topic>Sex Factors</topic><topic>Tomography, Emission-Computed, Single-Photon</topic><topic>Vascular dysfunction</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chan, Yap-Hang</creatorcontrib><creatorcontrib>Yiu, Kai-Hang</creatorcontrib><creatorcontrib>Lau, Kui-Kai</creatorcontrib><creatorcontrib>Yiu, Yuen-Fung</creatorcontrib><creatorcontrib>Li, Sheung-Wai</creatorcontrib><creatorcontrib>Lam, Tai-Hing</creatorcontrib><creatorcontrib>Lau, Chu-Pak</creatorcontrib><creatorcontrib>Siu, Chung-Wah</creatorcontrib><creatorcontrib>Tse, Hung-Fat</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Atherosclerosis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chan, Yap-Hang</au><au>Yiu, Kai-Hang</au><au>Lau, Kui-Kai</au><au>Yiu, Yuen-Fung</au><au>Li, Sheung-Wai</au><au>Lam, Tai-Hing</au><au>Lau, Chu-Pak</au><au>Siu, Chung-Wah</au><au>Tse, Hung-Fat</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>Atherosclerosis</jtitle><addtitle>Atherosclerosis</addtitle><date>2014-12</date><risdate>2014</risdate><volume>237</volume><issue>2</issue><spage>504</spage><epage>513</epage><pages>504-513</pages><issn>0021-9150</issn><eissn>1879-1484</eissn><abstract><![CDATA[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.
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.
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).
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.
•CHADS2/CHA2DS2-VASc predict atherosclerosis and CV events in patients without AF.•Incorporating PR prolongation improves the risk prediction.]]></abstract><cop>Ireland</cop><pub>Elsevier Ireland Ltd</pub><pmid>25463082</pmid><doi>10.1016/j.atherosclerosis.2014.08.026</doi><tpages>10</tpages></addata></record> |
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| subjects | Adverse cardiovascular events Aged Atrial Fibrillation - physiopathology Body Mass Index Cardiovascular continuum Cardiovascular Diseases - diagnosis Cardiovascular Diseases - physiopathology Carotid Intima-Media Thickness CHADS2 and CHA2DS2-VASc scores Dilatation Electrocardiography Female Follow-Up Studies Health Status Indicators Heart Failure - physiopathology Humans Male Middle Aged Myocardial Ischemia - pathology Nitroglycerin - chemistry PR prolongation Proportional Hazards Models Prospective Studies Pulse Wave Analysis Risk Assessment Risk Factors Risk prediction ROC Curve Sex Factors Tomography, Emission-Computed, Single-Photon Vascular dysfunction |
| 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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