Prediction of Embolic Stroke in Non-Valvular Atrial Fibrillation Patients with Low CHADS-VASc Score

Abstract

Background: Clinical research revealed that thromboembolic events are still a possibility for AF patients with low CHA2DS2-VASc scores.  

Aim: To assess the ability of certain echocardiographic parameters and laboratory biomarkers to predict thromboembolic events in AF  patients with low CHA2DS2-VASc score

Methods: This is a case-control study at the Cardiology Department, Zagazig University Hospitals  and Nasser Institute for Research. and Treatment was conducted on 159 patients: group 1 included 53 nonvalvular AF patients having low  CHA2DS2-VASc score with Acute Ischemic Stroke (AIS), group 2 included 53 non-valvular AF patients having low CHA2DS2-VASc score  but without AIS and group 3 included 53 controls without AF or AIS. All groups were investigated by certain echocardiography parameters  including left atrial emptying fraction (LAEF), left atrial volume index (LAVI) left atrial appendage flow velocity(LAA FV), mitral  annular velocity (E′) and E/e′ ratio, also they were investigated by some laboratory markers including platelet count, red cell distribution  width (RDW), platelet distribution width(PDW), creatinine level, D-dimer level, and troponin I.

Results: The Receiver Operating  Characteristic (ROC) curve analysis showed that several echocardiographic parameters had significant predictive value for stroke, these  parameters were LAVI, LAeF, E/e' ratios, and LAAFV.Also, the ROC curve analysis showed that PDW, D-dimer, and troponin had significant predictive value. A novel stroke risk scoring model was developed

Conclusions: The novel stroke risk score model may enhance the  prediction of LAA thrombus in non-valvular AF patients with low CHADS-VASc score (0 in males,1 in females)