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

Yap Hang Chan; Kai Hang Yiu; Kui Kai Lau; Yuen Fung Yiu; Sheung Wai Li; Tai Hing Lam; Chu Pak Lau; Chung Wah Siu; Hung Fat Tse

doi:10.1016/j.atherosclerosis.2014.08.026

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

Yap Hang Chan, Kai Hang Yiu, Kui Kai Lau, Yuen Fung Yiu, Sheung Wai Li, Tai Hing Lam, Chu Pak Lau, Chung Wah Siu, Hung Fat Tse

Research output: Contribution to journal › Article › peer-review

56 Citations (Scopus)

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.

Original language	English
Pages (from-to)	504-513
Number of pages	10
Journal	Atherosclerosis
Volume	237
Issue number	2
DOIs	https://doi.org/10.1016/j.atherosclerosis.2014.08.026
Publication status	Published - Dec 1 2014
Externally published	Yes

Bibliographical note

Publisher Copyright:
© 2014 Elsevier Ireland Ltd.

ASJC Scopus Subject Areas

Cardiology and Cardiovascular Medicine

Keywords

Adverse cardiovascular events
Cardiovascular continuum
CHADS and CHADS-VASc scores
PR prolongation
Risk prediction
Vascular dysfunction

Access to Document

10.1016/j.atherosclerosis.2014.08.026

Cite this

Chan, Y. H., Yiu, K. H., Lau, K. K., Yiu, Y. F., Li, S. W., Lam, T. H., Lau, C. P., Siu, C. W., & Tse, H. F. (2014). 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. Atherosclerosis, 237(2), 504-513. https://doi.org/10.1016/j.atherosclerosis.2014.08.026

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. / Chan, Yap Hang; Yiu, Kai Hang; Lau, Kui Kai et al.
In: Atherosclerosis, Vol. 237, No. 2, 01.12.2014, p. 504-513.

Research output: Contribution to journal › Article › peer-review

Chan, YH, Yiu, KH, Lau, KK, Yiu, YF, Li, SW, Lam, TH, Lau, CP, Siu, CW & Tse, HF 2014, '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', Atherosclerosis, vol. 237, no. 2, pp. 504-513. https://doi.org/10.1016/j.atherosclerosis.2014.08.026

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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",

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.",

keywords = "Adverse cardiovascular events, Cardiovascular continuum, CHADS and CHADS-VASc scores, PR prolongation, Risk prediction, Vascular dysfunction",

author = "Chan, {Yap Hang} and Yiu, {Kai Hang} and Lau, {Kui Kai} and Yiu, {Yuen Fung} and Li, {Sheung Wai} and Lam, {Tai Hing} and Lau, {Chu Pak} and Siu, {Chung Wah} and Tse, {Hung Fat}",

note = "Publisher Copyright: {\textcopyright} 2014 Elsevier Ireland Ltd.",

year = "2014",

month = dec,

day = "1",

doi = "10.1016/j.atherosclerosis.2014.08.026",

language = "English",

volume = "237",

pages = "504--513",

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TY - JOUR

T1 - The CHADS2 and CHA2DS2-VASc scores predict adverse vascular function, ischemic stroke and cardiovascular death in high-risk patients without atrial fibrillation

T2 - Role of incorporating PR prolongation

AU - Chan, Yap Hang

AU - Yiu, Kai Hang

AU - Lau, Kui Kai

AU - Yiu, Yuen Fung

AU - Li, Sheung Wai

AU - Lam, Tai Hing

AU - Lau, Chu Pak

AU - Siu, Chung Wah

AU - Tse, Hung Fat

PY - 2014/12/1

Y1 - 2014/12/1

N2 - 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.

AB - 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.

KW - Adverse cardiovascular events

KW - Cardiovascular continuum

KW - CHADS and CHADS-VASc scores

KW - PR prolongation

KW - Risk prediction

KW - Vascular dysfunction

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