Sá Tiago, Sargento-Freitas João, Pinheiro Vítor, Martins Rui, Teixeira Rogério, Silva Fernando, Mendonça Nuno, Cordeiro Gustavo, Gonçalves Lino, Providência Luís A, Freire-Gonçalves António, Cunha Luís
Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal.
Rev Port Cardiol. 2013 May;32(5):373-8. doi: 10.1016/j.repc.2012.09.007. Epub 2013 Apr 6.
Cardioembolism is one of the most common causes of ischemic stroke, with an estimated prevalence of 20-30%, and correct diagnosis is essential given the therapeutic implications. Although stroke risk scores (CHADS2 and more recently CHA2DS2-VASc) have been validated in heterogeneous populations of patients with atrial fibrillation, their accuracy has not been ascertained for secondary stroke prevention. We set out to assess the sensitivity and specificity of the CHADS2 and CHA2DS2-VASc stroke risk scores as predictors of cardioembolic sources, documented by transesophageal echocardiography (TEE) in a population with ischemic stroke.
The CHADS2 and CHA2DS2-VASc scores were applied to all patients admitted to the stroke unit/neurology ward of a Portuguese tertiary hospital with atrial fibrillation (diagnosed previously or during or after admission) who underwent TEE between January and August 2011. The presence of a cardioembolic source was defined as the observation by TEE of spontaneous echo contrast in the left atrium and atrial appendage or thrombi in the left cardiac chambers.
We studied 94 patients, 66.0% male, mean age 64.4 years (standard deviation 14.2). A cardioembolic source was detected in 20 patients. ROC curve analysis identified as predictors of cardioembolic source CHADS2 score ≥4 (sensitivity of 75.0%, specificity of 66.0%, p=0.014) and CHA2DS2-VASc score ≥5 (sensitivity of 83.3%, specificity of 58.0%, p=0.009).
Both scores showed acceptable sensitivity as predictors of embolic risk in the context of secondary prevention of cardioembolic stroke. The CHA2DS2-VASc score has higher sensitivity than CHADS2 but lower specificity.
心源性栓塞是缺血性卒中最常见的病因之一，估计患病率为20%-30%，鉴于其治疗意义，正确诊断至关重要。尽管卒中风险评分（CHADS2以及最近的CHA2DS2-VASc）已在心房颤动患者的异质性群体中得到验证，但其在二级卒中预防中的准确性尚未确定。我们旨在评估CHADS2和CHA2DS2-VASc卒中风险评分作为心源性栓塞来源预测指标的敏感性和特异性，这些来源通过经食管超声心动图（TEE）在缺血性卒中患者群体中得以记录。
CHADS2和CHA2DS2-VASc评分应用于2011年1月至8月期间入住葡萄牙一家三级医院卒中单元/神经内科病房且患有心房颤动（入院前、入院期间或入院后诊断）并接受TEE检查的所有患者。心源性栓塞来源的存在定义为TEE观察到左心房和心耳内的自发回声增强或左心腔内的血栓。
我们研究了94例患者，男性占66.0%，平均年龄64.4岁（标准差14.2）。20例患者检测到心源性栓塞来源。ROC曲线分析确定CHADS2评分≥4（敏感性75.0%，特异性66.0%，p=0.014）和CHA2DS2-VASc评分≥5（敏感性83.3%，特异性58.0%，p=0.009）为心源性栓塞来源的预测指标。
在预防心源性栓塞性卒中的二级预防中，这两种评分作为栓塞风险预测指标均显示出可接受的敏感性。CHA2DS2-VASc评分比CHADS2评分具有更高的敏感性，但特异性较低。
