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Published on: July 20, 2022
Development and Validation of a Nomogram for Estimating Stroke Risk in Nonvalvular Atrial Fibrillation Patients With
Decai Zeng1, Xiangling Cao2, Yongzhi Cai1
1Department of Ultrasonic Medicine, First Affiliated Hospital of Guangxi Medical University, Nanning, China, gxmu.edu.cn.
Cardiovascular Therapeutics
|July 16, 2026
Summary
Nonvalvular atrial fibrillation (NVAF) patients at risk for stroke can be better assessed using a new nomogram. This tool incorporates left atrial (LA) stiffness and other factors to predict stroke risk more accurately than existing models.
Area of Science:
- Cardiology
- Medical Imaging
- Risk Stratification
Background:
- Nonvalvular atrial fibrillation (NVAF) significantly increases ischemic stroke risk.
- Current stroke risk assessment models may not fully capture NVAF-related risks.
- Echocardiographic parameters, such as left atrial (LA) stiffness, warrant investigation for improved risk stratification.
Purpose of the Study:
- To assess the clinical significance of echocardiographic left atrial (LA) stiffness in NVAF patients.
- To develop and validate a nomogram integrating clinical and echocardiographic data for individualized stroke risk prediction in NVAF.
- To compare the predictive performance of the novel nomogram against existing stroke risk scores.
Main Methods:
- A cohort of 402 NVAF patients was retrospectively analyzed.
- Patients were divided into training (n=281) and validation (n=121) datasets.
- Logistic regression identified independent predictors; a nomogram was constructed and validated using ROC, calibration, and decision curve analyses.
Main Results:
- Left atrial (LA) stiffness, LA reservoir strain (LASr), hypertension, peripheral vascular disease, and anticoagulation were identified as independent stroke risk factors.
- The nomogram demonstrated excellent discrimination (C-statistic: 0.889 training, 0.880 validation), outperforming the CHA2DS2-VASc score.
- Higher LA stiffness correlated with impaired left atrial appendage (LAA) function and was associated with LA thrombus/spontaneous echocardiographic contrast.
Conclusions:
- A nomogram incorporating LA stiffness, LASr, hypertension, and peripheral vascular disease effectively predicts stroke risk in NVAF patients.
- An extended model including anticoagulation further improved performance, requiring prospective validation.
- Elevated LA stiffness may contribute to stroke development in NVAF by affecting LAA hemodynamics.