CHA2DS2-VASc Score Is Correlated with Cardiac Performance in Chronic Atrial Fibrillation

Background: The CHA2DS2-VASc score is a popular tool for risk prediction of thromboembolism in patients with atrial fibrillation (AF). Each component of the CHA2DS2VASc scheme is an established risk factor for left ventricular diastolic dysfunction and heart failure (HF). In AF patients, HF is often adversely affecting to clinical outcomes including thromboembolism. We hypothesized that the CHA2DS2-VASc score reflects cardiac reserve and the risk of HF as well as the risk of stroke in patients with AF. Methods: A total of 103 patients who had the diagnosis of chronic non-valvular AF patients with preserved ejection fraction (EF) were enrolled consecutively. CHA2DS2-VASc score was compared to exercise capacity (peak oxygen uptake, peak VO2), B-type natriuretic peptide (BNP) and echocardiographic diastolic dysfunction index (early mitral to annular velocity, E/E′) ratio. Results: Exercise capacity was correlated with age (β=−0.568, p<0.001), CHA2DS2-VASc score (β=−0.526, p<0.001), BNP (β=−0.449, p<0.001) and diastolic dysfunction (β=−0.534, p<0.001). Patients with CHA2DS2-VASc score ≥2 had a significantly less exercise capacity than those with CHA2DS2-VASc score <2 (p<0.001). Higher CHA2DS2-VASc score was associated with lower exercise capacity, more diastolic dysfunction and higher BNP (for trend p=0.001). Conclusions: High CHA2DS2-VASc score is associated with poor exercise capacity in patients with AF. Diastolic dysfunction is thought to be the major mechanism of exercise limitation. CHA2DS2-VASc score might be useful for predicting overall cardiac reserve as well as stroke risk stratification in AF patients.