Ischemic Stroke in Non-Gender-Related CHA(2)DS(2)-VA Score 0~1 Is Associated With H(2)FPEF Score Among the Patients With Atrial Fibrillation

BACKGROUND: Ischemic strokes (ISs) can appear even in non-gender-related CHA(2)DS(2)-VA scores 0~1 patients with atrial fibrillation (AF). We explored the determinants associated with IS development among the patients with non-gender-related CHA(2)DS(2)-VA score 0~1 AF. METHODS AND RESULTS: In this single-center retrospective registry data for AF catheter ablation (AFCA), we included 1,353 patients with AF (24.7% female, median age 56 years, and paroxysmal AF 72.6%) who had non-gender-related CHA(2)DS(2)-VA score 0~1, normal left ventricular (LV) systolic function, and available H(2)FPEF score. Among those patients, 113 experienced IS despite a non-gender-related CHA(2)DS(2)-VA score of 0~1. All included patients underwent AFCA, and we evaluated the associated factors with IS in non-gender-related CHA(2)DS(2)-VA score 0~1 AF. Patients with ISs in this study had a lower estimated glomerular filtration rate (eGFR) (p < 0.001) and LV ejection fraction (LVEF; p = 0.017), larger LA diameter (p < 0.001), reduced LA appendage peak velocity (p < 0.001), and a higher baseline H(2)FPEF score (p = 0.018) relative to those without ISs. Age [odds ratio (OR) 1.11 (1.07–1.17), p < 0.001, Model 1] and H(2)FPEF score as continuous [OR 1.31 (1.03–1.67), p = 0.028, Model 2] variable were independently associated with ISs by multivariate analysis. Moreover, the eGFR was independently associated with IS at low CHA(2)DS(2)-VA scores in both Models 1 and 2. AF recurrence was significantly higher in patients with IS (log-rank p < 0.001) but not in those with high H(2)FPEF scores (log-rank p = 0.079), respectively. CONCLUSIONS: Among the patients with normal LVEF and non-gender-related CHA(2)DS(2)-VA score 0~1 AF, the high H(2)FPEF score, and increasing age were independently associated with IS development (ClinicalTrials.gov Identifier: NCT02138695).