Both HFpEF and HFmrEF should be included in calculating CHA2DS2-VASc score: A Taiwanese longitudinal cohort

被引：3

作者：

Cheng, Chien-Chien ^{[1
]}

Huang, Pang-Shuo ^{[2
,3
,4
]}

Chen, Jien-Jiun ^{[2
]}

Chiu, Fu-Chun ^{[2
]}

Chang, Sheng-Nan ^{[2
]}

Wang, Yi-Chih ^{[5
]}

Wu, Cho-Kai ^{[5
]}

Hwang, Juey-Jen ^{[5
]}

Tsai, Chia-Ti ^{[5
]}

机构：

[1] Natl Taiwan Univ, Coll Med, Taipei, Taiwan

[2] Natl Taiwan Univ Hosp, Dept Internal Med, Div Cardiol, Yunlin Branch, Touliu, Yunlin, Taiwan

[3] Natl Taiwan Univ, Grad Inst Clin Med, Coll Med, Taipei, Taiwan

[4] Natl Taiwan Univ Hosp, Cardiovasc Ctr, Taipei, Taiwan

[5] Natl Taiwan Univ Hosp, Dept Internal Med, Div Cardiol, Taipei, Taiwan

来源：

HEART RHYTHM | 2024年 / 21卷 / 09期

关键词：

Atrial fibrillation; HFrEF; HFmrEF; HFpEF; CHA(2)DS(2)-VASc score; Ischemic stroke; PRESERVED EJECTION FRACTION; HEART-FAILURE; ATRIAL-FIBRILLATION; RISK-FACTOR; STROKE;

D O I：

10.1016/j.hrthm.2024.02.048

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Congestive heart failure (CHF) as a risk of stroke in patients with atrial fi brillation (AF) mainly referred to patients with left ventricular systolic dysfunction. Whether this should include patients with preserved ejection fraction is debatable. OBJECTIVE The study aimed to investigate the variation in stroke risk of AF patients with heart failure with preserved ejection fraction (HFpEF), heart failure with mid-range ejection fraction (HFmrEF), and heart failure with reduced ejection fraction (HFrEF) for enhancing risk assessment and subsequent management strategies. METHODS In a longitudinal study using the National Taiwan University Hospital integrated Medical Database, 8358 patients with AF were observed for 10 years (mean follow-up, 3.76 years). The study evaluated the risk of ischemic stroke in patients with differing ejection fractions and CHA(2)DS(2)-VASc score, further using Cox models adjusted for risk factors of AF-related stroke. RESULTS Patients with HFpEF and HFmrEF had a higher mean CHA(2)DS(2)-VASc score compared with patients with HFrEF (4.30 +/- 1.729 vs 4.15 +/- 1.736 vs 3.73 +/- 1.712; P < .001) and higher risk of stroke during follow-up (hazard ratio [HR], 1.40 [1.161-1.688; P < .001] for HFmrEF; HR, 1.184 [1.075-1.303; P = . 001] for HFpEF vs no CHF) after multivariate adjustment). In patients with lower CHA(2)DS(2)-VASc score (0-4), presence of any type of CHF increased ischemic stroke risk (HFrEF HR, 1.568 [1.189-2.068; P = . 001]; HFmrEF HR, 1.890 [1.372-2.603; P < .001]; HFpEF HR, 1.800 [1.526-2.123; P < .001] vs no CHF). CONCLUSION After multivariate adjustment, HFpEF and HFmrEF showed a similar risk of stroke in AF patients. Therefore, it is important to extend the criteria for C in the CHA(2)DS(2)-VASc score to include patients with HFpEF and HFmrEF. In patients with fewer concomitant stroke risk factors, the presence of any subtype of CHF increases risk for ischemic stroke.

引用

页码：1500 / 1506

页数：7

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