Echocardiographic parameters versus CHA₂ds₂-vasc score in prediction of overall cardiac events, heart failure, and stroke in non-valvular atrial fibrillation

Background: Apart from stroke, atrial fibrillation (AF) is associated with higher mortality and heart failure (HF), in which risk stratification scheme is lacking. Therefore this investigation examined the prognostic value of echocardiographic predictors against CHA₂DS₂-VASc score in permanent non--valvular AF (NVAF). Methods: In 252 asymptomatic or mildly symptomatic consecutive patients with NVAF, comprehensive echocardiography was performed. Left atrial deformation parameters were also obtained by two-dimensional speckle tracking echocardiography. End-points pertaining to HF deterioration, ischemic stroke and cardiac death were recorded. Results: There were 74 cardiovascular events, including 44 deterioration of HF, 22 ischemic strokes and 8 cardiovascular deaths during an average follow-up period of 20.8 ± 13.5 months (interquartile range, 8–31 months). For prediction of overall prognosis and HF, left ventricular mass index, peak early filling velocity (E), and E to tissue Doppler mitral annular early diastolic velocity ratio (E/e’) outperformed CHA₂DS₂-VASc score in multivariate analysis, area under curve, and stepwise nested regression models. Left ventricular hypertrophy and E/e’ > 8 showed worse overall and heart-failure free survival in Kaplan-Meier curves. For prediction of ischemic stroke, the addition of E or E/e’ to CHA₂DS₂-VASc score provides extra prognostic value. Conclusions: Echocardiographic parameters offer incremental value over CHA₂DS₂-VASc score for prediction of future cardiac events in NVAF.