Division of Cardiology, Population Health Research Institute, McMaster University, 237 Barton St. E. Hamilton, ON L8L 2X2, Canada.
Department of Medicine, The Cardiac Clinic, Groote Schuur Hospital, University of Caape Town, Cape Town, South Africa.
Cardiovasc Res. 2022 Jan 7;118(1):295-304. doi: 10.1093/cvr/cvaa344.
Patients with atrial fibrillation (AF) and rheumatic heart disease (RHD), especially mitral stenosis, are assumed to be at high risk of stroke, irrespective of other factors. We aimed to re-evaluate stroke risk factors in a contemporary cohort of AF patients.
We analysed data of 15 400 AF patients presenting to an emergency department and who were enrolled in the global RE-LY AF registry, representing 47 countries from all inhabited continents. Follow-up occurred at 1 year after enrolment. A total of 1788 (11.6%) patients had RHD. These patients were younger (51.4±15.7 vs. 67.8±13.6 years), more likely to be female (66.2% vs. 44.7%) and had a lower mean CHA2DS2-VASc score (2.1±1.7 vs. 3.7±2.2) as compared to patients without RHD (all P<0.001). Significant mitral stenosis (average mean transmitral gradient 11.5±6.5 mmHg) was the predominant valve lesion in those with RHD (59.6%). Patients with RHD had a higher baseline rate of anticoagulation use (60.4% vs. 45.2%, P<0.001). Unadjusted stroke rates at 1 year were 2.8% and 4.1% for patients with and without RHD, respectively. The performance of the CHA2DS2-VASc score was modest in both groups [stroke at 1 year, c-statistics 0.69, 95% confidence interval (CI) 0.60-0.78 and 0.63, 95% CI 0.61-0.66, respectively]. In the overall cohort, advanced age, female sex, prior stroke, tobacco use, and non-use of anticoagulation were predictors for stroke (all P<0.05). Mitral stenosis was not associated with stroke risk (adjusted odds ratio 1.07, 95% CI 0.67-1.72, P=0.764).
The performance of the CHA2DS2-VASc score was modest in AF patients both with and without RHD. In this cohort, moderate-to-severe mitral stenosis was not an independent risk factor for stroke.
患有心房颤动（AF）和风湿性心脏病（RHD）的患者，尤其是二尖瓣狭窄患者，被认为存在较高的中风风险，而不考虑其他因素。我们旨在重新评估当代 AF 患者队列中的中风危险因素。
我们分析了来自全球 RE-LY AF 注册登记处的 15400 名因房颤到急诊科就诊并接受登记的患者的数据，该登记处代表了来自所有有人居住的大陆的 47 个国家。随访在登记后 1 年进行。共有 1788 名（11.6%）患者患有 RHD。这些患者更年轻（51.4±15.7 岁 vs. 67.8±13.6 岁），更有可能是女性（66.2% vs. 44.7%），CHA2DS2-VASc 评分平均值较低（2.1±1.7 vs. 3.7±2.2）（均 P<0.001）。与无 RHD 的患者相比，显著的二尖瓣狭窄（平均平均跨瓣梯度 11.5±6.5mmHg）是 RHD 患者的主要瓣膜病变（59.6%）。RHD 患者的抗凝治疗基线使用率更高（60.4% vs. 45.2%，P<0.001）。无 RHD 患者的 1 年中风发生率为 2.8%，有 RHD 患者的 1 年中风发生率为 4.1%。两组 CHA2DS2-VASc 评分的性能均为中等[1 年时的中风发生率，C 统计量分别为 0.69（95%CI 0.60-0.78）和 0.63（95%CI 0.61-0.66]。在整个队列中，年龄较大、女性、既往中风、吸烟和未使用抗凝治疗是中风的预测因素（均 P<0.05）。二尖瓣狭窄与中风风险无关（校正比值比 1.07，95%CI 0.67-1.72，P=0.764）。
CHA2DS2-VASc 评分在有和无 RHD 的 AF 患者中的性能均为中等。在该队列中，中度至重度二尖瓣狭窄不是中风的独立危险因素。
