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      CHADS 2 and CHA 2DS 2-VASc Scores Predict the Risk of Ischemic Stroke Outcome in Patients with Interatrial Block without Atrial Fibrillation

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          Abstract

          Aim: To evaluate the role of CHADS 2 and CHA 2DS 2-VASc scores in predicting the risk of ischemic stroke or transient ischemic attack (TIA) outcomes in patients with interatrial block (IAB) without a history of atrial fibrillation (AF).

          Methods: A retrospective study was conducted, including 1,046 non-anticoagulated inpatients (612 males, 434 females; mean age: 63 ± 10 years) with IAB and without AF. IAB was defined as P-wave duration > 120 ms using a 12-lead electrocardiogram. CHADS 2 and CHA 2DS 2-VASc scores were retrospectively calculated. The primary outcomes evaluated were ischemic stroke or TIA.

          Results: During the mean follow-up period of 4.9 ± 0.7 years, 55 (5.3%) patients had an ischemic stroke or TIA. Receiver operating characteristic (ROC) curve analysis showed that the CHADS 2 score [area under the curve (AUC), 0.638; 95% confidence interval (CI), 0.562–0.715; P = 0.001] and the CHA 2DS 2-VASc score (AUC, 0.671; 95% CI, 0.599–0.744; P <0.001) were predictive of ischemic strokes or TIA. Cut-off point analysis showed that a CHADS 2 score ≥ 3 (sensitivity = 0.455 and specificity = 0.747) and a CHA 2DS 2-VASc score ≥ 4 (sensitivity = 0.564 and specificity = 0.700) provided the highest predictive value for ischemic stroke or TIA. The multivariate Cox regression analysis showed that CHADS 2 [hazard ratio (HR), 1.442; 95% CI, 1.171–1.774; P = 0.001] and CHA 2DS 2-VASc (HR, 1.420; 95% CI, 1.203–1.677; P <0.001) scores were independently associated with ischemic stroke or TIA following adjustment for smoking, left atrial diameter, antiplatelet agents, angiotensin inhibitors, and statins.

          Conclusions: CHADS 2 and CHA 2DS 2-VASc scores may be predictors of risk of ischemic stroke or TIA in patients with IAB without AF.

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          Most cited references37

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          The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. WHO MONICA Project Principal Investigators.

          A World Health Organization Working Group has developed a major international collaborative study with the objective of measuring over 10 years, and in many different populations, the trends in, and determinants of, cardiovascular disease. Specifically the programme focuses on trends in event rates for validated fatal and non-fatal coronary heart attacks and strokes, and on trends in cardiovascular risk factors (blood pressure, cigarette smoking and serum cholesterol) in men and women aged 25-64 in the same defined communities. By this means it is hoped both to measure changes in cardiovascular mortality and to see how far they are explained; on the one hand by changes in incidence mediated by risk factor levels; and on the other by changes in case-fatality rates, related to medical care. Population centres need to be large and numerous; to reliably establish 10-year trends in event rates within a centre 200 or more fatal events in men per year are needed, while for the collaborative study a multiplicity of internally homogeneous centres showing differing trends will provide the best test of the hypotheses. Forty-one MONICA Collaborating Centres, using a standardized protocol, are studying 118 Reporting Units (subpopulations) with a total population aged 25-64 (both sexes) of about 15 million.
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            Antithrombotic therapy to prevent stroke in patients with atrial fibrillation: a meta-analysis.

            To characterize the efficacy and safety of anticoagulants and antiplatelet agents for prevention of stroke in patients with atrial fibrillation. Randomized trials identified by using the search strategy developed by the Cochrane Collaboration Stroke Review Group. All published randomized trials testing antithrombotic agents to prevent stroke in patients with atrial fibrillation. Data on interventions, number of participants, duration of exposure and occurrence of all stroke (ischemic and hemorrhagic), major extracranial bleeding, and death were extracted independently by two investigators. Sixteen trials included a total of 9874 participants (mean follow-up, 1.7 years). Adjusted-dose warfarin (six trials, 2900 participants) reduced stroke by 62% (95% CI, 48% to 72%); absolute risk reductions were 2.7% per year for primary prevention and 8.4% per year for secondary prevention. Major extracranial bleeding was increased by warfarin therapy (absolute risk increase, 0.3% per year). Aspirin (six trials, 3119 participants) reduced stroke by 22% (CI, 2% to 38%); absolute risk reductions were 1.5% per year for primary prevention and 2.5% per year for secondary prevention. Adjusted-dose warfarin (five trials, 2837 participants) was more efficacious than aspirin (relative risk reduction, 36% [CI, 14% to 52%]). Other randomized comparisons yielded inconclusive results. Adjusted-dose warfarin and aspirin reduce stroke in patients with atrial fibrillation, and warfarin is substantially more efficacious than aspirin. The benefit of antithrombotic therapy was not offset by the occurrence of major hemorrhage among participants in randomized trials. Judicious use of antithrombotic therapy, tailored according to the inherent risk for stroke, importantly reduces stroke in patients with atrial fibrillation.
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              Structural and functional remodeling of the left atrium: clinical and therapeutic implications for atrial fibrillation.

              Left atrial (LA) structural and functional remodeling reflects a spectrum of pathophysiological changes that have occurred in response to specific stressors. These changes include alterations at the levels of ionic channels, cellular energy balance, neurohormonal expression, inflammatory response, and physiologic adaptations. There is convincing evidence demonstrating an important pathophysiological association between LA remodeling and atrial fibrillation (AF). Measures that will prevent, attenuate, or halt these processes of LA remodeling may have a major public health impact with respect to the epidemic of AF. In this review, we describe the mechanisms involved in LA remodeling and highlight the existing and potential therapeutic options for its reversal, and implications for AF development.
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                Author and article information

                Journal
                J Atheroscler Thromb
                J. Atheroscler. Thromb
                jat
                jat
                Journal of Atherosclerosis and Thrombosis
                Japan Atherosclerosis Society
                1340-3478
                1880-3873
                1 February 2017
                : 24
                : 2
                : 176-184
                Affiliations
                [1 ]Department of Cardiology, Henan Provincial People's Hospital (Zhengzhou University People's Hospital), Zhengzhou, China
                [2 ]Department of Cardiology, Center for Atrial Fibrillation, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
                Author notes
                Address for correspondence: Shan-Ling Wang, Department of Cardiology, Henan Provincial People's Hospital (Zhengzhou University People's Hospital), Zhengzhou, China E-mail: ycksyy@ 123456126.com
                Article
                10.5551/jat.34900
                5305678
                27301462
                8ddefc56-317f-45ef-9afd-eaef6e260887
                2017 Japan Atherosclerosis Society

                This article is distributed under the terms of the latest version of CC BY-NC-SA defined by the Creative Commons Attribution License. http://creativecommons.org/licenses/by-nc-sa/3.0/

                History
                : 19 January 2016
                : 17 May 2016
                Page count
                Figures: 3, Tables: 2, References: 45, Pages: 9
                Categories
                Original Article

                chads2,cha2ds2-vasc,interatrial block,ischemic stroke,transient ischemic attack

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