In patients with non-valvular atrial fibrillation, ischemic stroke occurred in 20.28% and was independently predicted by LAA thrombus/SEC (AOR 3.07, p=0.004) and inadequate anticoagulation.
Observational (n=350)
No
What are the independent predictors of ischemic stroke in patients with non-valvular atrial fibrillation?
In patients with non-valvular AF, clinical and echocardiographic factors such as inadequate anticoagulation, left atrial enlargement, and LAA thrombus independently predict ischemic stroke and may enhance risk stratification beyond the CHA₂DS₂-VASc score.
Odds Ratio: 3.07
valor p: p=0.004
Background Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a major cause of ischemic stroke (IS). Although the Congestive heart failure (or left ventricular dysfunction), Hypertension, Age ≥ 75 years, Diabetes mellitus, prior Stroke, transient ischemic attack (TIA), or thromboembolism, Vascular disease (prior heart attack, peripheral artery disease, or aortic plaque), Age 65 to 74 years, and Sex category (Female) or CHA₂DS₂-VASc score is widely used for stroke risk stratification, additional clinical, treatment-related, and echocardiographic factors may influence stroke risk. This study aimed to determine the frequency of IS and identify its independent predictors among patients with non-valvular AF. Methods This retrospective study included 350 patients with non-valvular AF treated at a tertiary care hospital in Rawalpindi, Pakistan. Demographic, clinical, anticoagulation, CHA₂DS₂-VASc, and echocardiographic data were extracted from medical records. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States). Group comparisons were conducted using the independent-samples t-test and chi-square test, followed by multivariable logistic regression to identify independent predictors of IS. Results From the total study population, 71 (20.28%) experienced IS. Patients with stroke had a significantly higher mean CHA₂DS₂-VASc score than those without stroke (4.50 ± 1.40 vs. 3.20 ± 1.20, p<0.001). On initial analysis, age ≥65 years, previous stroke/TIA, vascular disease, smoking, chronic kidney disease, inadequate anticoagulation, left atrial enlargement, reduced left ventricular ejection fraction (LVEF<40%), left atrial appendage (LAA) thrombus/spontaneous echo contrast (SEC), and CHA₂DS₂-VASc score ≥4 were significantly associated with IS (all p<0.05). Multivariable logistic regression confirmed age ≥65 years (adjusted odds ratio (AOR)=2.59; p=0.003), previous stroke/TIA (AOR=2.37; p=0.012), vascular disease (AOR=1.88; p=0.045), smoking (AOR=1.93; p=0.039), chronic kidney disease (AOR=2.12; p=0.028), inadequate anticoagulation (AOR=2.90; p=0.001), left atrial enlargement (AOR=2.32; p=0.007), reduced LVEF (AOR=1.94; p=0.042), and LAA thrombus/SEC (AOR=3.07; p=0.004) as independent predictors of IS. Conclusion IS was observed in a considerable proportion of patients with non-valvular AF. IS was independently associated with advanced age, previous stroke/TIA, vascular disease, smoking, chronic kidney disease, inadequate anticoagulation, left atrial enlargement, reduced LVEF, and LAA thrombus/SEC. Assessment of these factors, in addition to the CHA₂DS₂-VASc score, may enhance risk stratification and facilitate timely implementation of preventive strategies.
Jabbar et al. (Sun,) conducted a observational in Non-valvular Atrial Fibrillation (n=350). Left atrial appendage (LAA) thrombus/spontaneous echo contrast (SEC) vs. Absence of LAA thrombus/SEC was evaluated on Ischemic stroke (OR 3.07, p=0.004). In patients with non-valvular atrial fibrillation, ischemic stroke occurred in 20.28% and was independently predicted by LAA thrombus/SEC (AOR 3.07, p=0.004) and inadequate anticoagulation.