Predictive Factors Of Ischemic Stroke Occurrence In The Elderly Inpatients With Non-valvular Atrial Fibrillation

ObjectiveTo investigate predictive factors of ischemic stroke?IS?occurrence in the elderly inpatients??60 years?with non-valvular atrial fibrillation?NVAF?.MethodsThe elderly inpatients?age?60 years?with NVAF in Fujian Medical University Union Hospital were enrolled during January 2013 to June 2017.The patients were divided into NVAF group and NVAF+IS group according to whether they were combined with IS or not.The factors influencing the occurrence of IS in the elderly inpatients with NVAF were studied by multivariate Logistic regression analysis,and the prediction value of the factors was discussed by using Receiver Operating Characteristic?ROC?curve.Results1.A total of 314 inpatients met the inclusion criteria were enrolled in this study.There were 239 patients?76.11%,169 males and 70 females,average age72.2±7.1 years?in NVAF group.While,there were 75 patients?23.68%,49 males and 26females,average age 74.1±8.1 years?in NVAF+IS group.The incidence of ischemic stroke was 23.68%in the elderly inpatients with NVAF.2.Gender,smoking,heart rate?HR?,body surface area?BSA?,body mass index?BMI?,lipid levels,and comorbidities of diabetes,coronary heart disease?CHD?and heart failure?HF?in the NVAF group were not significantly different in the NVAF+IS group?P?0.05?.The average age,comorbidities of hypertension and peripheral vascular diseases in NVAF+IS group were higher than those in NVAF group respectively?P?0.05?,while the estimated glomerular fitration rate?eGFR?was lower than that in NVAF group?P?0.05?.Left ventricular ejection fraction?LVEF?,interventricular septal thickness?IVS?,left ventricular end diastolic diameter?LVED?and left ventricular end systolic diameter?LVES?in the NVAF group were not significantly different in the NVAF+IS group?P?0.05?.The left atrial diameter?LAD?,left atrial diameter index?LADI?,left ventricular mass?LVM?and left ventricular mass index?LVMI?in NVAF+IS group were higher than those in NVAF group respectively?P?0.05?.3.Multivariate Logistic regression analysis showed that eGFR?60ml/min/1.73m²,LAD,LADI,LVM and LVMI had significant influence on the occuring of IS in the elderly inpatients with NVAF repestively?P?0.05?.4.The area under Receiver Operating Characteristic curve of CHADS₂,CHA₂DS₂-VASc,LADI and eGFR predicted that the happening of IS in the elderly inpatients with NVAF were 0.541,0.525,0.577 and 0.577 respectively.CHADS₂and CHA2DS2-VASc have a similar ability to predict the occurring of IS in the elderly inpatients with NVAF.Meanwhile,LADI and eGFR also had predictive value for the risk of IS in the elderly inpatients with NVAF.Furthermore,the predictive ability of LADI and eGFR were comparable to CHADS₂ and CHA₂DS₂-VASc respectively.The area under ROC curve of CHADS₂ combined with both LADI and eGFR was higher than that of CHADS₂ alone,CHADS₂ combined with LADI and CHADS₂ combined with eGFR respectively?P<0.05?.The area under ROC curve of CHA₂DS₂-VASc combined with both LADI and eGFR was higher than that of CHA₂DS₂-VASc alone,CHA2DS2-VASc combined with LADI and CHA2DS2-VASc combined with eGFR respectively?P<0.05?.Conclusions1.The incidence of IS in the elderly inpatients with NVAF was 23.89%.2.The value of CHADS₂ in predicting the risk of IS in the elderly inpatients with NVAF is the same as to CHA2DS2-VASc.3.The predictive value of LADI,eGFR for IS in the elderly inpatients with NVAF is similar to CHADS₂,CHA₂DS₂-VASc respectively.4.The predictive ability of CHADS₂?CHA₂DS₂-VASc combined with eGFR and LADI in the elderly inpatients with NVAF is higher than CHADS₂?CHA₂DS₂-VASc respectively.