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Predictive Values of the CHA2DS2-VASc Score and Left Atrial Diameter for Cerebral Small Vessel Disease in Geriatric
Anıl Tanburoglu1, Ismail Karluka2, Sevda Diker3
1Neurology, Başkent University, Adana, TUR.
Insights
The CHA2DS2-VASc score and left atrial diameter (LAD) did not predict cerebral microbleeds (CMBs) in elderly atrial fibrillation stroke patients. However, in diabetics, the CHA2DS2-VASc score indicated CMBs, and higher LAD increased CMB risk.
Area of Science:
- Neurology
- Cardiology
- Radiology
Background:
- Atrial fibrillation is a common cause of ischemic stroke in older adults.
- Cerebral small vessel disease (cSVD), including white matter hyperintensities and cerebral microbleeds (CMBs), is frequently observed in these patients.
- Predictive markers for cSVD in this population are crucial for risk stratification.
Purpose of the Study:
- To investigate if the CHA2DS2-VASc score and left atrial diameter (LAD) predict cerebral microbleeds (CMBs) in patients over 65 with atrial fibrillation-related ischemic stroke.
- To assess the association between these clinical and echocardiographic parameters and the presence and burden of CMBs.
Main Methods:
- Retrospective analysis of 60 patients (>65 years) with atrial fibrillation-related ischemic stroke.
- CHA2DS2-VASc score calculation and transthoracic echocardiography for LAD measurement.
- Brain MRI (FLAIR, SWI) to assess white matter hyperintensities (Fazekas score) and CMBs, with categorization by CMB burden.
Main Results:
- CHA2DS2-VASc score did not significantly predict CMBs (p=0.08).
- In patients with diabetes mellitus, higher CHA2DS2-VASc scores correlated with increased CMB burden.
- Elevated LAD was associated with a higher risk of CMBs in patients with coronary artery disease.
Conclusions:
- LAD and CHA2DS2-VASc scores are not reliable predictors of CMBs in elderly atrial fibrillation stroke patients.
- The CHA2DS2-VASc score may have predictive value for CMBs in diabetic patients.
- Increased LAD is linked to higher CMB risk in patients with coronary artery disease.
Abstract:
Objective The objective of this study was to determine whether the CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes mellitus, stroke, vascular disease, age, sex) score and left atrial diameter (LAD) could predict the presence of cerebral small vessel disease (cSVD) in patients older than 65 years with atrial fibrillation as the cause of ischemic stroke. Materials and methods In this study, we included patients over 65 years of age who had suffered an ischemic stroke caused by atrial fibrillation within 30 days after the onset of symptoms. The data recorded included demographics, electrocardiograms, Holter monitors, and echocardiography reports. The anteroposterior LAD, determined by transthoracic echocardiography, was analyzed. Each patient's CHA2DS2-VASc score was calculated. Brain magnetic resonance imaging (MRI) assessed white matter hyperintensities (WMH) on fluid-attenuated inversion recovery (FLAIR) images and cerebral microbleeds (CMBs) on susceptibility-weighted sequences. The Fazekas score, based on WMH on MRI, was used to grade the severity of gliosis. Participants were categorized into three groups according to their quantitative CMB burden. Findings The study included 60 participants, with a mean age of 80 years (range 65-99), and 43.3% (n = 26) were male. The CHA2DS2-VASc score had a mean value of 4.21 (range 2-8), and the mean LAD was 4.17 (range 2.6-5.3) cm. The CHA2DS2-VASc score did not predict CMBs (OR, 1.389; 95% CI, 0.961-2.008, p = 0.08) in geriatric stroke patients with atrial fibrillation. However, in the subgroup of patients with diabetes mellitus, the CHA2DS2-VASc score was higher in those with CMB 1-4 and CMB ≥ 5 than in those without CMB. Additionally, the risk of CMBs 1-4 increased with higher LAD compared to patients without LAD. Conclusion The LAD and CHA2DS2-VASc scores were not significantly associated with CMB prediction in elderly stroke patients with atrial fibrillation. In a diabetes mellitus subgroup, the CHA2DS2-VASc score was indicative of CMB. An increased LAD elevates the risk of CMBs in patients with coronary artery disease.
