Background: In patients with non-valvular atrial fibrillation (NVAF), the CHA2DS2-VASc risk factors (Congestive heart failure, Hypertension, Age, Diabetes, prior Stroke/transient ischemic attack, vascular disease, female sex) are known to be associated with developing ischemic stroke. However, the mechanisms how the CHA2DS2-VASc risk factors increase the risk of ischemic stroke in NVAF has not been well understood in terms of the pathophysiologies of thrombogenesis. Virchow’s triad, including atrial tissue damage, hypercoagulable state, and blood stasis, was proposed to play a role in the pathophysiologic mechanism of thrombogenesis in NVAF, and blood stasis in AF occurs not only because of loss of atrial systole but also in relation to left atrial dilatation. The aim of this study was to evaluate the relationship between CHA2DS2-VASc risk factors and left atrial enlargement. We also assessed which factors among the CHA2DS2-VASc risk factors are most contributable to left atrial enlargement.
Methods: Consecutive patients with acute ischemic stroke and NVAF who were anticoagulation-naïve were enrolled. Left atrial volume (LAV) and left atrial volume index (LAVI) were assessed using the biplane area-length method, following the American Society of Echocardiography standard guidelines. The association between CHA2DS2-VASc risk factors and left atrial enlargement were assessed. The contribution of each individual burden of CHA2DS2-VASc risk factors to left atrial enlargement was also evaluated.
Results: A total of 98 patients who presented with acute ischemic stroke due to NVAF were enrolled. Correlation analysis showed that total CHA2DS2-VASc score was significantly correlated with left atrial volume index (r=0.33, p=0.002). The regression analysis showed that hypertension (t=0.25, p=0.014), congestive heart failure (t=0.20, p=0.045) and peripheral vascular disease (t=0.39, p<0.001) among the CHA2DS2-VASc scores were associated with left atrial enlargement.
Conclusion: The CHA2DS2-VASc scores, particularly hypertension, congestive heart failure and peripheral vascular disease, were associated left atrial enlargement (LAE) in patients with acute ischemic stroke due to NVAF.