Association of the CHA2D(S2)-VASc Score and Its Components With Overt and Silent Ischemic Brain Lesions in Patients With Atrial Fibrillation

Abstract

Background: Silent and overt ischemic brain lesions are common and associated with adverse outcome. Whether the CHA2DS2-VASc score and its components predict magnetic resonance imaging (MRI)-detected ischemic silent and overt brain lesions in patients with atrial fibrillation (AF) is unclear. Methods: In this cross-sectional analysis, patients with AF were enrolled in a multicenter cohort study in Switzerland. Outcomes were clinically overt, silent [in the absence of a history of stroke/transient ischemic attack (TIA)] and any MRI-detected ischemic brain lesions. Logistic regression analyses were performed to assess the relationship of the CHA2DS2-VASc score and its components with ischemic brain lesions. An adapted CHA2D-VASc score (excluding history of stroke/TIA) for the analyses of clinically overt and silent ischemic brain lesions was used. Results: Overall, 1,741 patients were included in the analysis (age 73 ± 8 years, 27.4% female). At least one ischemic brain lesion was observed in 36.8% (clinically overt: 10.5%; silent: 22.9%; transient ischemic attack: 3.4%). The CHA2D-VASc score was strongly associated with clinically overt and silent ischemic brain lesions {odds ratio (OR) [95% confidence interval (CI)] 1.32 (1.17-1.49), p < 0.001 and 1.20 (1.10-1.30), p < 0.001, respectively}. Age 65-74 years (OR 2.58; 95%CI 1.29-5.90; p = 0.013), age ≥75 years (4.13; 2.07-9.43; p < 0.001), hypertension (1.90; 1.28-2.88; p = 0.002) and diabetes (1.48; 1.00-2.18; p = 0.047) were associated with clinically overt brain lesions, whereas age 65-74 years (1.95; 1.26-3.10; p = 0.004), age ≥75 years (3.06; 1.98-4.89; p < 0.001) and vascular disease (1.39; 1.07-1.79; p = 0.012) were associated with silent ischemic brain lesions. Conclusions: A higher CHA2D-VASc score was associated with a higher risk of both overt and silent ischemic brain lesions. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02105844.

Keywords: CHA2DS2-VASc score; atrial fibrillation; ischemic brain lesion; silent ischemic brain lesion; stroke.

Conflict of interest statement

MK has received grants from the Swiss National Science Foundation, the Swiss Heart Foundation, Bayer and Pfizer-BMS, he has received lecture/consulting fees from Daiichi-Sankyo, Boehringer Ingelheim, Bayer, Pfizer-BMS, AstraZeneca, Sanofi-Aventis, Novartis, MSD, Medtronic, Boston Scientific, St. Jude Medical, Biotronik, Sorin, Zoll, and Biosense Webster. DC received consulting fees from Servier, Canada, outside of the presented work. NR has received a grant from the Swiss Heart Foundation. LB has received grants from the Swiss National Science Foundation, the University of Basel, the Swiss Heart Foundation, The Stroke Association, and AstraZeneca; and has received consulting and advisory board fees from Amgen, Bayer, Bristol-Myers Squibb, and Claret Medical. CC has received grants from the Swiss Heart Foundation and advisory board fees from Bayer, Medtronic, Boehringer Ingelheim and Pfizer. TR has received research grants from the Goldschmidt-Jacobson Foundation, the Swiss National Science Foundation, the Swiss Heart Foundation, the European Union, the Professor Max Cloëtta Foundation, the Cardiovascular Research Foundation Basel, the University of Basel and the University Hospital Basel, all outside of the presented work. He has received speaker/consulting honoraria or travel support from Abbott/SJM, Astra Zeneca, Brahms, Bayer, Biosense-Webster, Medtronic, Pfizer-BMS and Roche, all outside of the presented work. He has received support for his institution's fellowship program (Inselspital Bern) from Biosense-Webster, Biotronik, Medtronic, Abbott/SJM and Boston Scientific, all outside of the presented work. MB has received a grant from the Swiss National Science Foundation. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Steiner, Meyre, Aeschbacher, Coslovsky, Sinnecker, Blum, Rodondi, Cereda, di Valentino, Wenger, Cussigh, Krisai, Roten, Reichlin, Conen, Osswald, Bonati, Kühne and the Swiss-AF Investigators.

Figures

Figure 1

Brain magnetic resonance imaging showing (A) small non-cortical infarct (B) small cortical infarcts, and (C) large non-cortical and cortical infarcts.

Figure 2

Prevalence of ischemic brain lesions stratified by the adapted CHA2D-VASc score. Abbreviations: TIA, transient ischemic attack. aExcluding history of stroke/TIA (S2). Female patients with a CHA2D-VASc score of 1 were assigned to the category of CHA2D-VASc score 0. Clinically overt ischemic brain lesions were defined as ischemic brain lesions in patients with a history of stroke. Silent ischemic brain lesions were defined as ischemic brain lesions in patients without a history of stroke/TIA.