Cardiac Structural or Functional Changes Associated with CHA(2)DS(2)-VASc Scores in Nonvalvular Atrial Fibrillation: A Cross-Sectional Study Using Echocardiography

BACKGROUND: CHA(2)DS(2)-VASc is the most widely accepted scoring system for atrial fibrillation (AF) to assess stroke risk, although little has been revealed regarding the accompanying cardiac functional/structural changes. This echocardiography study was undertaken to understand the changes related to CHA(2)DS(2)-VASc scores. METHODS: A total of 4,795 nonvalvular AF patients were enrolled for the cohort, from which 591 were excluded as they did not meet the inclusion criteria. Based on the CHA(2)DS(2)-VASc scores, the remaining 4,204 patients included in the study were divided into 4 groups: 0 to 1 (n = 991); 2 to 3 (n = 1,642); 4 to 6 (n = 1,407); 7 to 9 (n = 164). RESULTS: Increase in the left ventricular mass index and prevalence of left ventricular hypertrophy (LVH) were observed with elevating CHA(2)DS(2)-VASc scores (p < 0.05 for all). Diastolic parameters such as left atrial volume index (LAVI) and the ratio of early diastolic mitral inflow velocity to early diastolic velocity of the mitral annulus (E/E′) also increased significantly in the higher CHA(2)DS(2)-VASc score groups (p < 0.001 for all), although two-way ANOVA analysis showed that such incremental diastolic impairment was independent of hypertension. LVH (hazard ratio [HR], 3.609; confidence interval [CI], 2.426–5.369; p < 0.001) and E/E′ (HR, 1.087; CI, 1.054–1.121; p < 0.001) were independent risk factors for CHA(2)DS(2)-VASc scores 2 or higher. CONCLUSIONS: Our findings suggest that increasing CHA(2)DS(2)-VASc scores are associated with impaired diastolic function that may represent high left atrial pressure favoring thrombogenic propensity.