Department of Cardiology, The Third Affiliated Hospital of Anhui Medical University (The First People's Hospital of Hefei), Hefei, 230001, Anhui, China.
Sci Rep. 2024 Mar 21;14(1):6844. doi: 10.1038/s41598-024-57497-x.
To investigate the clinical significance of the CHADS-VASc-60 score, lipoprotein (a) [Lp(a)], red blood cell distribution width (RDW), and their combined effect in patients with non-valvular atrial fibrillation (NVAF) who experience acute ischemic stroke (AIS). This retrospective analysis was conducted on the clinical data of hospitalized patients with NVAF at the Third Affiliated Hospital of Anhui Medical University between April 1, 2020, and April 1, 2023. Based on the diagnosis of acute ischemic stroke (AIS), the patients were divided into two groups: the AIS group (150 cases of NVAF patients with comorbid AIS) and the non-AIS group (163 cases of NVAF patients without AIS). We performed CHADS-VASc-60 scoring for all patients and collected their laboratory indicators and echocardiographic indicators during hospitalization. The study comprised 313 individuals with NVAF in total. There is a statistically significant difference (P < 0.05) in the comparison of CHADS-VASc-60 score (5.68 ± 1.12 vs. 3.67 ± 1.47), Lp(a) [23.98 (13.28, 42.22) vs. 14.32 (7.96, 21.91)] and RDW (13.67 ± 1.25 vs. 12.94 ± 0.76) between NVAF patients with and without concomitant AIS. The results of the Spearman correlation analysis demonstrate a positive association between Lp(a) and RDW levels and both the CHADS-VASc score and the CHADS-VASc-60 score in patients with NVAF. Multivariate logistic regression analysis revealed that CHADS-VASc-60 score [OR = 6.549, 95% CI: 4.110-10.433, P < 0.05], Lp(a) [OR = 1.023, 95% CI: 1.005-1.041, P < 0.05], and RDW [OR = 1.644, 95% CI: 1.071-2.525, P < 0.05] were independent risk factors for AIS in patients with non-valvular atrial fibrillation (NVAF). The receiver operator characteristic (ROC) curves showed that the area under the curve of CHADS-VASc-60 score, Lp(a), RDW, and CHADS-VASc-60 score combined with Lp(a) and RDW predicted that NVAF patients with AIS were 0.881 [95% CI: 0.804-0.906], 0.685 [95% CI: 0.626-0.744], 0.695 [95% CI: 0.637-0.754], and 0.906 [95% CI: 0.845-0.921], respectively. The CHADS-VASc-60 score, Lp(a), and RDW were significantly increased in NVAF patients with AIS, which were independent risk factors for NVAF patients with AIS. The combination of the three has a high predictive capacity for NVAF patients with AIS.
探讨 CHADS-VASc-60 评分、脂蛋白（a）[Lp（a）]、红细胞分布宽度（RDW）及其联合作用在伴有急性缺血性脑卒中（AIS）的非瓣膜性心房颤动（NVAF）患者中的临床意义。本回顾性分析纳入了 2020 年 4 月 1 日至 2023 年 4 月 1 日期间在安徽医科大学第三附属医院住院的 NVAF 患者的临床资料。根据急性缺血性脑卒中（AIS）的诊断，将患者分为两组：AIS 组（150 例伴有 AIS 的 NVAF 患者）和非 AIS 组（163 例无 AIS 的 NVAF 患者）。我们对所有患者进行 CHADS-VASc-60 评分，并收集他们住院期间的实验室指标和超声心动图指标。本研究共纳入 313 例 NVAF 患者。NVAF 伴或不伴 AIS 患者的 CHADS-VASc-60 评分（5.68±1.12 与 3.67±1.47）、Lp（a）[23.98（13.28，42.22）与 14.32（7.96，21.91）]和 RDW（13.67±1.25 与 12.94±0.76）比较差异有统计学意义（P<0.05）。Spearman 相关分析结果显示，NVAF 患者的 Lp（a）和 RDW 水平与 CHADS-VASc 评分和 CHADS-VASc-60 评分呈正相关。多变量 logistic 回归分析显示，CHADS-VASc-60 评分[OR=6.549，95%CI：4.110-10.433，P<0.05]、Lp（a）[OR=1.023，95%CI：1.005-1.041，P<0.05]和 RDW[OR=1.644，95%CI：1.071-2.525，P<0.05]是非瓣膜性心房颤动（NVAF）患者发生 AIS 的独立危险因素。受试者工作特征（ROC）曲线显示，CHADS-VASc-60 评分、Lp（a）、RDW 以及 CHADS-VASc-60 评分联合 Lp（a）和 RDW 预测 NVAF 患者发生 AIS 的曲线下面积分别为 0.881[95%CI：0.804-0.906]、0.685[95%CI：0.626-0.744]、0.695[95%CI：0.637-0.754]和 0.906[95%CI：0.845-0.921]。AIS 组 NVAF 患者的 CHADS-VASc-60 评分、Lp（a）和 RDW 均显著升高，均为 NVAF 患者发生 AIS 的独立危险因素。三者联合具有较高的预测 AIS 能力。
