Salbach Christian, Yildirim Mustafa, Milles Barbara Ruth, Hund Hauke, Mueller-Hennessen Matthias, Frey Norbert, Katus Hugo, Giannitsis Evangelos
Department of Internal Medicine III, Cardiology, University Hospital of Heidelberg, Heidelberg, Germany.
PLoS One. 2025 Aug 21;20(8):e0330164. doi: 10.1371/journal.pone.0330164. eCollection 2025.
Guidelines of the European Society of Cardiology recommend a clinical risk assessment for patients with atrial fibrillation (AF). However, scores such as the CHA2DS2-VASc score show only a modest performance for prediction of adverse endpoints.
This retrospective single-center all-comer study uses data from the Heidelberg Registry of Atrial Fibrillation of 9,995 patients with non-valvular AF presenting to the emergency department (ED) of the University Hospital of Heidelberg from June 2009 until March 2020. Per CHA2DS2-VASc, risk was classified as low (0 point in men, ≤ 1 point in females), intermediate, or high (≥2 points in men and ≥3 points in females). The predictive performance of the CHA2DS2-VASc score, with and without highly sensitive cardiac troponin T (hs-cTnT), was evaluated for a composite endpoint comprising stroke, myocardial infarction (MI) or all-cause mortality.
Performance of the CHA2DS2-VASc score for the prediction of the composite endpoint was poor Area under the curve (AUC): 0.648 (95%CI: 0.638-0.657) particularly in patients at intermediate-risk AUC: 0.542 (95%CI: 0.508-0.575). Adding hs-cTnT improved discrimination substantially in intermediate-risk patients (AUC: 0.778, 95% CI: 0.748-0.805). Notably, no events occurred in intermediate-risk patients with undetectable hs-cTnT (<5 ng/L).
In patients with AF at intermediate thromboembolic risk, the addition of hs-cTnT to the CHA₂DS₂-VASc score enhances prediction of adverse cardiovascular outcomes. Hs-cTnT may help identify patients who could benefit from anticoagulation, while also identifying a low-risk subgroup unlikely to experience events.
欧洲心脏病学会指南建议对心房颤动（AF）患者进行临床风险评估。然而，诸如CHA2DS2-VASc评分等在预测不良终点方面表现一般。
这项回顾性单中心全人群研究使用了海德堡心房颤动登记处的数据，该登记处收集了2009年6月至2020年3月期间到海德堡大学医院急诊科就诊的9995例非瓣膜性AF患者的数据。根据CHA2DS2-VASc，风险分为低风险（男性0分，女性≤1分）、中度风险或高风险（男性≥2分，女性≥3分）。评估了有和没有高敏心肌肌钙蛋白T（hs-cTnT）时CHA2DS2-VASc评分对包括中风、心肌梗死（MI）或全因死亡率在内的复合终点的预测性能。
CHA2DS2-VASc评分对复合终点的预测性能较差，曲线下面积（AUC）：0.648（95%CI：0.638 - 0.657），特别是在中度风险患者中AUC：0.542（95%CI：0.508 - 0.575）。添加hs-cTnT显著改善了中度风险患者的辨别能力（AUC：0.778，95%CI：0.748 - 0.805）。值得注意的是，hs-cTnT检测不到（<5 ng/L）的中度风险患者未发生任何事件。
在中度血栓栓塞风险的AF患者中，将hs-cTnT添加到CHA₂DS₂-VASc评分中可增强对不良心血管结局的预测。Hs-cTnT可能有助于识别可从抗凝治疗中获益的患者，同时也能识别出不太可能发生事件的低风险亚组。
