Risk Factors Of Ischemic Stroke Induced By Non-valvular Atrial Fibrillation Based On CHA2DS2-VASc Score

Objective:1.To determine the predictive value of important risk factors(such as uric acid,glomerular filtration rate(e GFR),D-dimer,homocysteine,etc.)besides the factors included in CHA2DS2-VASc score for ischemic stroke in non-valvular atrial fibrillation.2.To refine the relevant factors in CHA2DS2-VASc score,to evaluate its predictive value for ischemic stroke caused by non-valvular atrial fibrillation,and to clarify the differences among clinical indicators.Methods:The clinical data of 200 patients with atrial fibrillation admitted to Ningbo Seventh Hospital from January 2016 to September 2018 were collected and analyzed retrospectively.Application of computed tomography(CT)or magnetic resonance imaging(MRI)in the diagnosis of ischemic stroke.There are two groups: AF with ischemic stroke and AF alone.Age,sex,heart rate,blood pressure,blood sugar,D-dimer(D-D),fibrinogen,uric acid,glomerular filtration rate(e GFR),low density lipoprotein,homocysteine and so on were compared between the two groups.Differences between general data and biochemical data.The related factors in CHA2DS2-VASc score were subdivided to explore its predictive value for ischemic stroke in non-valvular atrial fibrillation.Logistic regression analysis and ROC curve analysis model were used to explore the predictive value of important risk factors other than those included in CHA2DS2-VASc score for ischemic stroke in patients with non-valvular atrial fibrillation.Results:1.The levels of age,hypertension,heart failure,stroke,systolic and diastolic blood pressure in the combined group were significantly higher than those in the simple atrial fibrillation group,but the heart rate in the combined group was significantly lower than that in the non-combined group(P < 0.05).There was no significant difference in other indicators such as gender,diabetes incidence and peripheral vascular disease between the two groups.2.Fibrinogen,DD and homocysteine in the combined group were significantly higher than those in the non-combined group,but e GFR in the combined group was significantly lower than that in the non-combined group(P < 0.05).There was no significant difference in uric acid,creatinine and LDL among the three groups.3.The scores of CHADS2 and CHA2DS2-VASc in the combined group were significantly higher than those in the non-combined group,with t value-6.777 and P value less than 0.001.Among 87 patients with non-valvular atrial fibrillation and stroke,25%(22 cases)were at low or middle risk of CHADS2 score,while 93%(81 cases)were at high risk of CHA2DS2-VASc score(> 2 points),and the CHA2DS2-VASc score could be better distinguished.Really low-risk patients.4.Multivariate logistic regression analysis showed that age,systolic blood pressure,DD and previous stroke history were independent risk factors for ischemic stroke caused by non-valvular atrial fibrillation;ROC curve showed that age,systolic blood pressure and DD had better sensitivity and specificity,and the optimal threshold values were 74.50 years old,137.5mm Hg and 0.28ng/ml,respectively.Conclusions:Both CHA2DS2-VASc and CHADS2 scoring systems can predict the risk of ischemic stroke caused by non-valvular atrial fibrillation,but the CHA2DS2-VASc scoring system can better identify the real low-risk patients.The clinical characteristics of ischemic stroke caused by nonvalvular atrial.fibrillation are higher age,higher D dimer and higher systolic pressure level.