AUTHOR=Kim Min , Yu Hee Tae , Kim Tae-Hoon , Lee Dae-In , Uhm Jae-Sun , Kim Young Dae , Nam Hyo Suk , Joung Boyoung , Lee Moon-Hyoung , Heo Ji Hoe , Pak Hui-Nam 

TITLE=Ischemic Stroke in Non-Gender-Related CHA2DS2-VA Score 0~1 Is Associated With H2FPEF Score Among the Patients With Atrial Fibrillation

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=8

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.791112

DOI=10.3389/fcvm.2021.791112

ISSN=2297-055X

ABSTRACT=<sec><title>Background</title><p>Ischemic strokes (ISs) can appear even in non-gender-related CHA<sub>2</sub>DS<sub>2</sub>-VA scores 0~1 patients with atrial fibrillation (AF). We explored the determinants associated with IS development among the patients with non-gender-related CHA<sub>2</sub>DS<sub>2</sub>-VA score 0~1 AF.</p></sec><sec><title>Methods and Results</title><p>In this single-center retrospective registry data for AF catheter ablation (AFCA), we included 1,353 patients with AF (24.7% female, median age 56 years, and paroxysmal AF 72.6%) who had non-gender-related CHA<sub>2</sub>DS<sub>2</sub>-VA score 0~1, normal left ventricular (LV) systolic function, and available H<sub>2</sub>FPEF score. Among those patients, 113 experienced IS despite a non-gender-related CHA<sub>2</sub>DS<sub>2</sub>-VA score of 0~1. All included patients underwent AFCA, and we evaluated the associated factors with IS in non-gender-related CHA<sub>2</sub>DS<sub>2</sub>-VA score 0~1 AF. Patients with ISs in this study had a lower estimated glomerular filtration rate (eGFR) (<italic>p</italic> &lt; 0.001) and LV ejection fraction (LVEF; <italic>p</italic> = 0.017), larger LA diameter (<italic>p</italic> &lt; 0.001), reduced LA appendage peak velocity (<italic>p</italic> &lt; 0.001), and a higher baseline H<sub>2</sub>FPEF score (<italic>p</italic> = 0.018) relative to those without ISs. Age [odds ratio (OR) 1.11 (1.07–1.17), <italic>p</italic> &lt; 0.001, Model 1] and H<sub>2</sub>FPEF score as continuous [<italic>OR</italic> 1.31 (1.03–1.67), <italic>p</italic> = 0.028, Model 2] variable were independently associated with ISs by multivariate analysis. Moreover, the eGFR was independently associated with IS at low CHA<sub>2</sub>DS<sub>2</sub>-VA scores in both Models 1 and 2. AF recurrence was significantly higher in patients with IS (log-rank <italic>p</italic> &lt; 0.001) but not in those with high H<sub>2</sub>FPEF scores (log-rank <italic>p</italic> = 0.079), respectively.</p></sec><sec><title>Conclusions</title><p>Among the patients with normal LVEF and non-gender-related CHA<sub>2</sub>DS<sub>2</sub>-VA score 0~1 AF, the high H<sub>2</sub>FPEF score, and increasing age were independently associated with IS development (<ext-link ext-link-type="uri" xlink:href="https://ClinicalTrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">ClinicalTrials.gov</ext-link> Identifier: NCT02138695).</p></sec>