Escala CHA2 DS2 -VASc como predictor de severidad de ictus en pacientes con fibrilación auricular.

CHA2 DS2 -VASc score as a predictor of stroke severity in patients with atrial fibrillation

Keywords: stroke, atrial fibrillation, CHA 2 DS 2 -VASc score, 6S stroke severity score

Abstract

The CHA2 DS 2 -VASc score was created as a predictive instrument of risk of embolic stroke occurrence in patients with atrial fibrillation (AF), for therapeutic decisions. This score was not created as a tool to assess ischemic stroke severity in patients with AF, although the components of the score are associated with the formation, size, and growth of thrombus in the left atrium. Based on this, we assessed the possible utility of CHA2 DS 2-VASc score as a predictor of ischemic stroke severity in patients with stroke and AF, using the simplified 6S score as an indicator. Observational, prospective, and cross-sectional study, in which the CHA2 DS 2-VASc score was evaluated concerning the degree of ischemic stroke severity, using the 6S score as a reference for correlation analysis in patients hospitalized with stroke and AF in the emergency room of the Ciudad Hospitalaria “Dr. Enrique Tejera”, from January- September 2022. The median age was 71 [41-76] years, 55.3% were female, 85.9% had hypertension; 42.4% diabetes, 31.8% previous stroke; 14% heart failure and 16.5% had previous AF. Only 5.9% of the patients received anticoagulation when admitted. The median [p25-p75] was 5 [4-6] points for the CHA2 DS 2 -VASc score and 11 [8-11] points for 6S score. Both scores had a significant association (19.2%, R= 0.19, p <0.001. This study using the 6S severity score as an indicator, showed that CHA 2 DS 2-VASc, could be a useful clinical tool to predict stroke severity.

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Author Biographies

Miguel López-Hidalgo, Ciudad Hospitalaria “Dr. Enrique Tejera”. Valencia, Venezuela.

Postgrado de Cardiología, Ciudad Hospitalaria “Dr. Enrique Tejera”. Valencia, Venezuela.

Luis Pinto-Longart, Ciudad Hospitalaria “Dr. Enrique Tejera”, Valencia, Venezuela.

Postgrado de Neurología, Ciudad Hospitalaria “Dr. Enrique Tejera”, Valencia, Venezuela.

Antonio Eblen-Zajjur, Universidad Diego Portales, Santiago, Chile.

Laboratorio de Neurociencia Traslacional, Facultad de Medicina, Universidad Diego Portales, Santiago, Chile.

Euler Regis, Universidad de Carabobo, Valencia, Venezuela.

Facultad de Medicina, Universidad de Carabobo, Valencia, Venezuela.

José Reina, Universidad de Carabobo, Valencia, Venezuela.

Facultad de Medicina, Universidad de Carabobo, Valencia, Venezuela.

Ignacio Poggioli, Universidad de Carabobo, Valencia, Venezuela.

Facultad de Medicina, Universidad de Carabobo, Valencia, Venezuela.

José Ramírez, Universidad de Carabobo, Valencia, Venezuela.

Facultad de Medicina, Universidad de Carabobo, Valencia, Venezuela.

References

Braunwald E, Fauci S, Kasper DL, Hauser S, Longo D, Jameson. Enfermedades Cerebrovasculares. Editor: Serrano H. Harrison Principios de Medicina Interna. 20° Edición, McGraw-Hill Interamericana, Ciudad de México; 2020. p. 2609-12.

Steinberg JS, O’Conell H, Li S, Ziegler PD. Thirty-second gold standard definition of atrial fibrilation and its relationship with susequent arrythmia patterns. Circulation: Arrythm Electrophys. 2018; 11: e006274

Friberg L, Bergfedlt L. Atrial fibrillation prevalence revisited. J Intern Med. 2013, 274: 461-468.

Katsanos AH, Kamel H, Healey JS, Hart RG. Stroke prevention in atrial fibrilation. Circulation. 2020; 142:2371-2388.

Gage B, Waterman A, Shannon W, Boechler M, Rich MW, Radford MJ. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 2001; 285 (22): 2864-2870.

Hayashi T. Do the components of CHA DS-VAsc score affect stroke severity and outcome. Circ J 2016;80:74-75. https://www.jstage.jst.go.jp/article/circj/80/1/80_CJ-15-1201/_pdf

Jover E, Roldán V, Gallego P, Hernández-Romero D, Valdés M, Vicente V. Valor predictivo de la escala CHA DS-VASc en pacientes con fibrilación auricular de alto riesgo embólico en tratamiento anticoagulante. Rev Esp Cardiol 2012; 65, (6):627-633 https://www.revespcardiol.org/ es-valor-predictivo-escala-cha-2ds-articulo- S030089321200190X

Vitturi BK, Gagliardi RJ. Use of CHADS2 and CHA2 DS 2-VASc scores to predict prognosis after stroke. Rev Neurol 2020;176:85-91 https://www.sciencedirect.com/science/article/pii/S0035378719304692

Abellán Alemán J, Ruilope Urioste LM, Leal Hernández M, Armario García P, Tiberio López G, Martell Claros N. Control de los factores de riesgo cardiovascular en 2 2 VASc, and R2CHADS2 scores on severity and functional outcome in acute ischemic stroke with atrial fibrillation. J Stroke Cerebrovasc Dis 2015;24(7):1629–1635. http://dx.doi.org/10.1016/j.jstrokecere-brovasdis.2015.03.036

Tanaka K, Yamada T, Torii T, Furuta K, Matsumoto S, Yoshimura T, Kei-ichiro T, Yoshifumi W, Naoki N, Jun-ichi K., Hiroyuki M. Pre-admission CHADS2, CHA2 DS 2-VASc, and R2CHADS2 scores on severity and functional outcome in acute ischemic stroke with atrial fibrillation. J Stroke Cerebrovasc Dis 2015;24(7):1629–1635.http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2015.03.036

Leyden P., Brott T, Tilley B, Welch KM, Mascha E.J, Levine S, Haley EC, Grotta J, Marler J. Improves Reliability of the NIH stroke scale using video training. Stroke 1994; 25:2220-2226. https://www. ahajournals.org/doi/epdf/10.1161/01. STR.25.11.2220

Racosta JM, Di Guglielmo F, Klein FR, Riccio PM, Giacomelli FM, González ME. Stroke Severity Score based on Six Signs and Symptoms the 6S score: A simple tool for assessing stroke severity and in-hospital mortality. J Stroke 2014;16(3):178–183. Disponible en: https://pubmed.ncbi.nlm. nih.gov/25328876/

Racosta J, Klein F, Riccio P, Pagani-Cassar F, Gonzalez-Toledo M, Muñoz-Giacomelli F, Jauregui A, Sposato L. Simplified symptom-based score for the assessment of is chemic stroke severity. Neurology 2016;78 (1): Supp. 07.003. https://n.neurology. org/content/78/1_Supplement/P07.003

María R, Hidalgo V, Campello AR, Santiago O, Vivanco DRM. Monitorización cardiaca en la unidad de ictus: importancia del diagnóstico de fibrilación auricular en el ictus isquémico agudo. Rev. Esp Cardiol. 2009; 62(5):564-567. Disponible en: https:// www.redheracles.net/media/upload/research/pdf/194060711321522522.pdf

González Hernández A, Fabre Pi O, López Fernández JC, Díaz Nicolás S, Cabrera Hidalgo A. Factores de riesgo, etiología y pronóstico en pacientes con ictus isquémico y diabetes mellitus. Rev Clin Esp 2008;208(11):546–550. Disponible en: https://www.sciencedirect.com/science/ article/pii/S0014256508760314 pacientes con ictus atendidos en Atención Primaria en España. Estudio ICTUSCARE. Med Clin. 2011;136(8):329–335. Disponible en: https://www.sciencedirect.com/ science/article/pii/S0025775310009504

Abellán Alemán J, Ruilope Urioste LM, Leal Hernández M, Armario García P, Tiberio López G, Martell Claros N. Control de los factores de riesgo cardiovascular en pacientes con ictus atendidos en Atención Primaria en España. Estudio ICTUSCARE. Med Clin. 2011;136(8):329–335. Disponible en: https://www.sciencedirect.com/science/article/pii/S0025775310009504

Deguchi I, Hayashi T, Ohe Y, Kato Y, Nagoya H, Fukuoka T. The CHA(2)DS(2)-VASc score reflects clinical outcomes in non valvular atrial fibrillation patients with an initial cardioembolic stroke. J Stroke Cerebrovasc Dis 2013;22(8):e34334-6. Disponible en: http://dx.doi.org/10.1016/j. jstrokecerebrovasdis.2013.02.01817

Acciarresi M, Paciaroni M, Agnelli G, Falocci N, Caso V, Becattini C, Marcheselli S, Rueckert C, Pezzini A. Prestroke CHA2DS2-VASc Score and Severity of Acute Stroke in patients with atrial fibrillation, findings from RAF study. J Stroke & Cerebrovas Dis 2017, 26 (6): 1363-1368. https://doi.org/10.1016/j.jstrokecerebro- vasdis.2017.02.011

Nasifov M, Ozmen E, Deniz C, Nadir A. Association of CHA2DS2-VASc with suc- cessful recanalization in acute ischemic stroke patients undergoing endovascular thrombectomy. Adv Interv Cardiol 2022;18,3 (69):269-275.

Wu HM, Chung CP, Lin YY. Similar thrombolysis outcome in acute stroke patients with and without atrial fibrillation if prestroke CHA2DS2-VASc score is low. Medicine 2020; 99:2.

Published
2024-12-02
How to Cite
López-Hidalgo, M., Pinto-Longart, L., Eblen-Zajjur, A., Regis, E., Reina, J., Poggioli, I., & Ramírez, J. (2024). Escala CHA2 DS2 -VASc como predictor de severidad de ictus en pacientes con fibrilación auricular.: CHA2 DS2 -VASc score as a predictor of stroke severity in patients with atrial fibrillation. Investigación Clínica, 65(4), 418-425. https://doi.org/10.54817/IC.v65n4a02