The Predictive Role of the CHADS-VASc Score on Reduced Left Ventricular Ejection Fraction in Patients with Acute Coronary Syndrome

Year 2021, , 45 - 50, 29.01.2021

Uğur Küçük

https://doi.org/10.47482/acmr.2021.14

Abstract

Background: Reduced left ventricular systolic function is associated with significant mortality and morbidity in patients with the acute coronary syndrome (ACS). Predicting which patients may go on to develop heart failure (HF) with optimal treatment is thus likely to be effective in reducing mortality and morbidity. This study aims to evaluate the role of the CHA2DS2-VASc score in predicting reduced left ventricular ejection fraction (LVEF) in patients with ACS.

Methods: 202 patients diagnosed with the ACS participated in the study. Coronary angiography (CAG) was performed on all patients. The LVEF values of the patients before and three months after discharge were evaluated by transthoracic echocardiogram (TTE). Group 1 consisted of patients with LVEF values below 50% at the third month, while Group 2 consisted of those with LVEF values of 50% and above.

Results: The mean age of the patients was 62 ± 12 years, and 142 of the patients were male. The LVEF values in the third month were 55.58 ± 0.24 in Group 1 and 42.07 ± 0.86 in Group 2 (p<0.001). While the mean CHA2DS2-VASc score was 0.86 ± 0.78 in Group 1, it was 1.78 ± 0.87 in Group 2 (p<0.001). Multiple regression analysis showed that the CHA2DS2-VASc score had an independent relationship in predicting the LVEF values in patients with ACS (Odds ratio [OR] 3.179, 95% CI 1.972-5.124, p<0.001). CHA2DS2- VASc scores above 1.5 can be used as a predictor for decreased left ventricular systolic function in patients with ACS with 53% sensitivity and 80% specificity.

Conclusion: The CHA2DS2-VASc score is a simple and easy parameter that can be used to predict decreased and preserved left ventricular systolic functions in patients with ACS.

Keywords

CHA2DS2-VASc Score, Ejection Fraction, Acute Coronary Syndrome.

References

• 1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease and stroke statistics 2015 update: a report from the American Heart Association.Circulation. 2015;131(4):e29–e322.
• 2. Rich MW, Bosner MS, Chung MK, Shen J, McKenzie JP. Is age an independent predictor of early and late mortality in patients with acute myocardial infarction? Am J Med. 1992;92(1):7–13.
• 3. Durante A, Camici PG. Novel insights into an “old” phenom- enon: the no reflow. Int J Cardiol. 2015;187:273−80.
• 4. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37(38):2893- 962.
• 5. Agra Bermejo, R., Cordero, A., García-Acuña, J. M., Gómez Otero, et al. Determinants and Prognostic Impact of Heart Failure and Left Ventricular Ejection Fraction in Acute Coronary Syndrome Settings. Rev Esp Cardiol (Engl Ed). 2018;71(10):820-28.
• 6. Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019;40:87-165.
• 7. European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery, Camm AJ, Kirchhof P, Lip GY, Schotten U, et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J. 2010;31:2369−429.
• 8. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification. Eur J Echocardiogr. 2006;7(2):79-108.
• 9. Piché M-E, Poirier P, Lemieux I, Després J-P. Overview of epidemiology and contribution of obesity and body fat distribution to cardiovascular disease: an update. Prog Cardiovasc Dis. 2018;61(2):103-13.
• 10. Eckman MH, Lip GY, Wise RE, Speer B, Sullivan M, Walker N, et al. Impact of an Atrial Fibrillation Decision Support Tool on thromboprophylaxis for atrial fibrillation. Am Heart J. 2016;176:17-27.
• 11. Shuvy M, Zwas DR, Keren A, Gotsman I. Value of the CHA2 DS2 -VASc score for predicting outcome in patients with heart failure. ESC Heart Fail. 2020;7(5):2553-60.
• 12. Scudiero F, Zocchi C, De Vito E, Tarantini G, Marcucci R, Valenti R, et al. Relationship between CHA2DS2-VASc score, coronary artery disease severity, residual platelet reactivity and long-term clinical outcomes in patients with acute coronary syndrome. Int J Cardiol. 2018;262:9-13.
• 13. Widecka K, Safranow K, Lewandowski M, Przybycień K, Gorący J, Kornacewicz-Jach Z. Angiographic severity of coronary artery disease and cardiovascular risk in acute coronary syndrome in patients with metabolic syndrome. Kardiol Pol. 2018;76(3):662-68.
• 14. Chioncel O, Lainscak M, Seferovic PM, Anker SD, Crespo-Leiro MG, Harjola VP, et al. Epidemiology and one-year outcomes in patients with chronic heart failure and preserved, mid-range and reduced ejection fraction: an analysis of the esc heart failure long-term registry. Eur J Heart Fail. 2017;19(12):1574–85.
• 15. Shiny A, Bibin YS, Shanthirani CS, Regin BS, Anjana RM, Balasubramanyam M, et al. Association of neutrophil-lymphocyte ratio with glucose intolerance: an indicator of systemic inflammation in patients with type 2 diabetes. Diabetes Technol Ther. 2014;16(8):524- 30.
• 16. Monteiro S, Monteiro P, Gonçalves F, Freitas M, Providência LA. Hyperglycaemia at admission in acute coronary syndrome patients: prognostic value in diabetics and non-diabetics. Eur J Cardiovasc Prev Rehabil. 2010;17(2):155-9.
• 17. Zhang S, Diao J, Qi C, Jin J, Li L, Gao X, et al. Predictive value of neutrophil to lympho- cyte ratio in patients with acute ST segment elevation myocardial infarction after percutaneous coronary intervention: a meta-analysis. BMC Cardiovasc Disord. 2018;18(1):75.
• 18. Temizer O, Açar B, Yayla Ç, Ünal S, Göktuğ Ertem A, Gücük İpek E, et al. The Association between CHA2DS2-VASc Score and Mortality in Patients with Heart Failure with Reduced Ejection Fraction. Acta Cardiol Sin. 2017;33(4):429-35.
• 19. Temizer O, Açar B, Yayla Ç, Ünal S, Göktuğ Ertem A, Gücük İpek E, et al. The Association between CHA2DS2-VASc Score and Mortality in Patients with Heart Failure with Reduced Ejection Fraction. Acta Cardiol Sin. 2017;33(4):429-35.