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Sano M, Takegami M, Amano M, Tanaka H, Ando K, Kitai T, Miyake M, Komiya T, Izumo M, Kawai H, Eishi K, Yoshida K, Kimura T, Nawada R, Sakamoto T, Shibata Y, Fukui T, Minatoya K, Tsujita K, Sakata Y, Sugio K, Koyama T, Fujita T, Nishimura K, Izumi C, Furukawa Y. R 2-CHA 2DS 2-VASc Score for Cardiovascular Event Prediction After Bioprosthetic Valve Replacement - Subanalysis From the BPV-AF Registry. Circ Rep 2024; 6:341-348. [PMID: 39132334 PMCID: PMC11309778 DOI: 10.1253/circrep.cr-24-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/03/2024] [Accepted: 05/16/2024] [Indexed: 08/13/2024] Open
Abstract
Background There are few studies evaluating the prognostic prediction method in atrial fibrillation (AF) patients after bioprosthetic valve (BPV) replacement. The R2-CHA2DS2-VASc score is increasingly used for the prediction of cardiovascular (CV) events in patients with AF, device implantation, and acute coronary syndrome. We aimed to evaluate the predictive value of the R2-CHA2DS2-VASc score for future CV events in AF patients after BPV replacement. Methods and Results The BPV-AF, an observational, multicenter, prospective registry, enrolled AF patients who underwent BPV replacement. The primary outcome measure was a composite of stroke, systemic embolism, CV events including heart failure requiring hospitalization, and cardiac death. A total of 766 patients was included in the analysis. The mean R2-CHA2DS2-VASc score was 5.7±1.8. Low (scores 0-1), moderate (scores 2-4), and high (scores 5-11) R2-CHA2DS2-VASc score groups consisted of 12 (1.6%), 178 (23.2%), and 576 (75.2%) patients, respectively. The median follow-up period was 491 (interquartile range 393-561) days. Kaplan-Meier analysis showed a higher incidence of the composite CV events in the high R2-CHA2DS2-VASc score group (log rank test; P<0.001). Multivariate Cox proportional hazards regression analysis revealed that the R2-CHA2DS2-VASc score as a continuous variable was an independent predictor of composite CV outcomes (hazard ratio 1.36; 95% confidence interval 1.18-1.55; P<0.001). Conclusions The R2-CHA2DS2-VASc score is useful for CV risk stratification in AF patients after BPV replacement.
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Affiliation(s)
- Madoka Sano
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital Kobe Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center Osaka Japan
- Department of Public Health and Health Policy, Graduate School of Medicine, The University of Tokyo Tokyo Japan
| | - Masashi Amano
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center Osaka Japan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine Kobe Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital Kitakyushu Japan
| | - Takeshi Kitai
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center Osaka Japan
| | | | - Tatsuhiko Komiya
- Department of Public Cardiovascular Surgery, Kurashiki Central Hospital Okayama Japan
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine Kawasaki Japan
| | - Hiroya Kawai
- Department of Cardiology, Hyogo Prefectural Harima Himeji General Medical Center Hyogo Japan
| | - Kiyoyuki Eishi
- Department of Cardiovascular Surgery, Nagasaki University Hospital Nagasaki Japan
| | - Kiyoshi Yoshida
- Department of Cardiology, The Sakakibara Heart Institute of Okayama Okayama Japan
| | - Takeshi Kimura
- Division of Cardiology, Hirakata Kohsai Hospial Osaka Japan
| | - Ryuzo Nawada
- Department of Cardiology, Shizuoka City Shizuoka Hospital Shizuoka Japan
| | - Tomohiro Sakamoto
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center Kumamoto Japan
| | - Yoshisato Shibata
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center Miyazaki Japan
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kumamoto University Kumamoto Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University Kyoto Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University Kumamoto Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine Osaka Japan
| | - Kumiko Sugio
- Department of Primary Medical Science, Daiichi Sankyo Co., Ltd Tokyo Japan
| | - Tadaaki Koyama
- Department of Cardiovascular Surgery, Kansai Medical University Osaka Japan
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center Osaka Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center Osaka Japan
| | - Chisato Izumi
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center Osaka Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital Kobe Japan
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Gigante A, Imbimbo G, Andreini M, Proietti M, Palladino M, Molfino A, Alunni Fegatelli D, Muscaritoli M. CHA 2DS 2-VASc score as a predictor of clinical outcomes in hospitalized patients with and without chronic kidney disease. J Nephrol 2024; 37:409-417. [PMID: 37938543 PMCID: PMC11043197 DOI: 10.1007/s40620-023-01805-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/11/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND High CHA2DS2-VASc score (Congestive heart failure, Hypertension, Age > 75 years, Diabetes mellitus, prior Stroke or transient ischemic attack or thromboembolism, Vascular disease, Age 65-74 and Sex category) was associated with adverse clinical outcomes in different settings. The aim of the present study was to evaluate the association between CHA2DS2-VASc score and R2CHA2DS2-VASc score (which includes renal impairment) with in-hospital mortality and length of hospital stay in patients hospitalized in an internal medicine ward. METHODS We enrolled 983 consecutive patients admitted during 3 years in an internal medicine ward. R2CHA2DS2-VASc score was calculated by adding 2 points to CHA2DS2-VASc for the presence of chronic kidney disease (CKD), defined according to K-DOQI. The primary outcome was a composite of all-cause mortality and length of hospital stay > 10 days. RESULTS Patients with CKD stages 3-5 presented with increased CHA2DS2-VASc vs stages 1-2 (p < 0.001). The composite outcome occurred in 47.3% of inpatients. Multivariable linear logistic regression analyses adjusted for presence of infectious diseases and cancer, with the occurrence of composite outcome showed an adjusted OR of 1.349 (95% CI 1.248-1.462) and 1.254 (95% CI 1.179-1.336) for CHA2DS2-VASc and R2CHA2DS2-VASc scores, respectively. No differences were found in the association between CHA2DS2-VASc and R2CHA2DS2-VASc scores with the composite outcome (AUC 0.631 vs 0.630), and furthermore, adding the presence/absence of infectious diseases during hospitalization and positive cancer history to the models increased the AUC (0.667 and 0.663). CONCLUSIONS Incrementally higher CHA2DS2-VASc score is associated with increased length of hospital stay and mortality in patients hospitalized in an internal medicine ward, regardless of the presence of CKD.
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Affiliation(s)
- Antonietta Gigante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
| | - Giovanni Imbimbo
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Martina Andreini
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Marco Proietti
- Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Mariangela Palladino
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Alessio Molfino
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
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Li YP, Chen JY, Chen TW, Lu WD. Atrial high-rate episodes intensify R 2CHA 2DS 2-VASc score for prognostic stratification in pacemaker patients. Sci Rep 2023; 13:7640. [PMID: 37169860 PMCID: PMC10175262 DOI: 10.1038/s41598-023-34784-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 05/08/2023] [Indexed: 05/13/2023] Open
Abstract
Patients with device detected atrial high-rate episodes (AHRE) have an increased risk of MACE. The R2CHA2DS2-VASc, CHADS2, R2CHADS2 and CHA2DS2-VASc score have been investigated for predicting major adverse cardiovascular events (MACE) in different groups of patients. We aimed to evaluate the R2CHA2DS2-VASc score in combination with AHRE ≥ 6 min for predicting MACE in patients with dual-chamber PPM but no prior atrial fibrillation (AF). We retrospectively enrolled 376 consecutive patients undergoing dual-chamber PPM implantation and no prior AF. The primary endpoint was subsequent MACE. For all patients in the cohort, CHADS2, R2CHADS2, CHA2DS2-VASc, R2CHA2DS2-VASc scores and AHRE ≥ or < 6 min were determined. AHRE was recorded as a heart rate > 175 bpm (Medtronic) or > 200 bpm (Biotronik) lasting ≥ 30 s. Multivariate Cox regression analysis with time-dependent covariates was used to determine the independent predictors of MACE. ROC-AUC analysis was performed for CHADS2, R2CHADS2, CHA2DS2-VASc, and R2CHA2DS2-VASc scores and then adding AHRE ≥ 6 min to the four scores. The median age was 77 years, and 107 patients (28.5%) developed AHRE ≥ 6 min. After a median follow-up of 32 months, 46 (12.2%) MACE occurred. Multivariate Cox regression analysis showed that R2CHA2DS2-VASc score (HR, 1.485; 95% CI, 1.212-1.818; p < 0.001) and AHRE ≥ 6 min (HR, 2.125; 95% CI, 1.162-3.887; p = 0.014) were independent predictors for MACE. The optimal R2CHA2DS2-VASc score cutoff value was 4.5 (set at ≥ 5), with the highest Youden index (AUC, 0.770; 95% CI, 0.709-0.831; p < 0.001). ROC-AUC analysis of the four risk scores separately combined with AHRE ≥ 6 min all showed better discriminatory power than the four scores alone (All Z-statistic p < 0.05). In patients with PPM who develop AHRE ≥ 6 min, it is crucial to perform risk assessment with either four scores to further stratify risk for MACE.
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Affiliation(s)
- Yi-Pan Li
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 704, Taiwan
| | - Ju-Yi Chen
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 704, Taiwan.
| | - Tse-Wei Chen
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 704, Taiwan
| | - Wei-Da Lu
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 704, Taiwan
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Levy D, Gur E, Topaz G, Naser R, Kitay-Cohen Y, Benchetrit S, Sarel E, Cohen-Hagai K, Wand O. Mortality prediction using a modified R 2CHA 2DS 2-VASc score among hospitalized COVID-19 patients. Intern Emerg Med 2022; 17:1711-1717. [PMID: 35751741 PMCID: PMC9244353 DOI: 10.1007/s11739-022-02993-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/13/2022] [Indexed: 12/12/2022]
Abstract
The CHA2DS2-VASc score incorporates several comorbidities which have prognostic implications in COVID-19. We assessed whether a modified score (M-R2CHA2DS2-VASc), which includes pre-admission kidney function and male sex, could be used to classify mortality risk among people hospitalized with COVID-19. This retrospective study included adults admitted for COVID-19 between March and December 2020. Pre-admission glomerular filtration rate (GFR) was calculated based on serum creatinine and used for scoring M-R2CHA2DS2-VASc. Participants were categorized according to the M-R2CHA2DS2-VASc categories as 0-1 (low), 2-3 (intermediate), or ≥ 4 (high), and according to initial COVID-19 severity score. The primary outcome was 30-day mortality rates. Secondary outcomes were mortality rates over time, and rates of mechanical ventilation, hemodynamic support, and renal replacement therapy. Eight hundred hospitalizations met the study criteria. Participants were 55% males, average age was 65.2 ± 17 years. There were similar proportions of subjects across the M-R2CHA2DS2-VASc categories. 30-day mortality was higher in those in higher M-R2CHA2DS2-VASc category and with severe or critical COVID-19 at admission. Subjects in the low, intermediate, and high M-R2CHA2DS2-VASc categories had 30-day mortality rates of 4.7%, 17% and 31%, respectively (p < 0.001). Higher category was also associated with increased need for mechanical ventilation and renal replacement therapy. All-cause 90-day mortality remained significantly associated with M-R2CHA2DS2-VASc. The M-R2CHA2DS2-VASc score is associated with 30-day mortality rates among patients hospitalized with COVID-19, and adds predictive value when combined with initial COVID-19 severity.
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Affiliation(s)
- David Levy
- Department of Internal Medicine C, Meir Medical Center, Kfar Saba, Israel
| | - Efrat Gur
- Department of Internal Medicine C, Meir Medical Center, Kfar Saba, Israel
| | - Guy Topaz
- Department of Internal Medicine C, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rawand Naser
- Department of Internal Medicine C, Meir Medical Center, Kfar Saba, Israel
| | - Yona Kitay-Cohen
- Department of Internal Medicine C, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sydney Benchetrit
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Erez Sarel
- Department of Anesthesiology, Meir Medical Center, Kfar Saba, Israel
| | - Keren Cohen-Hagai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Ori Wand
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Institute of Pulmonary Medicine, Barzilai Medical Center, 2 Hahistadrut St, 7830604, Ashkelon, Israel.
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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