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CHADS(2) and CHA(2)DS(2)VASc scores as predictors of cardioembolic sources in secondary stroke prevention

Tiago Sá1, João Sargento-Freitas, Vítor Pinheiro

  • 1Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal.

Revista Portuguesa De Cardiologia : Orgao Oficial Da Sociedade Portuguesa De Cardiologia = Portuguese Journal of Cardiology : an Official Journal of the Portuguese Society of Cardiology
|April 10, 2013
PubMed

Insights

The CHADS2 and CHA2DS2-VASc scores can help predict cardioembolic stroke sources in patients with atrial fibrillation. CHA2DS2-VASc shows higher sensitivity for identifying embolic risk during secondary stroke prevention.

Area of Science:

  • Cardiology
  • Neurology
  • Medical Diagnostics

Background:

  • Cardioembolism is a major cause of ischemic stroke, accounting for 20-30% of cases.
  • Accurate diagnosis of cardioembolic sources is crucial for effective secondary stroke prevention.
  • Existing stroke risk scores (CHADS2, CHA2DS2-VASc) are validated in general atrial fibrillation populations but not specifically for secondary stroke prevention.

Purpose of the Study:

  • To evaluate the sensitivity and specificity of CHADS2 and CHA2DS2-VASc scores.
  • To assess their predictive accuracy for cardioembolic sources in ischemic stroke patients.
  • To determine their utility in secondary stroke prevention.

Main Methods:

  • A study of 94 patients with atrial fibrillation admitted to a Portuguese tertiary hospital between January and August 2011.
  • Application of CHADS2 and CHA2DS2-VASc scores to all patients who underwent transesophageal echocardiography (TEE).
  • Definition of cardioembolic source by TEE findings: spontaneous echo contrast or thrombi in left cardiac chambers.

Main Results:

  • A cardioembolic source was identified in 20 out of 94 patients.
  • ROC curve analysis showed CHADS2 score ≥4 predicted cardioembolic source with 75.0% sensitivity and 66.0% specificity (p=0.014).
  • CHA2DS2-VASc score ≥5 predicted cardioembolic source with 83.3% sensitivity and 58.0% specificity (p=0.009).

Conclusions:

  • Both CHADS2 and CHA2DS2-VASc scores demonstrated acceptable sensitivity for predicting embolic risk in secondary cardioembolic stroke prevention.
  • The CHA2DS2-VASc score exhibited higher sensitivity but lower specificity compared to the CHADS2 score.
Abstract

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