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Impact of atrial fibrillation on the development of ischemic stroke among cancer patients classified by CHA2DS2-VASc score-a nationwide cohort study.

ABSTRACT: The current study aimed to explore the impact of atrial fibrillation (AF) on risk of ischemic stroke among cancer patients classified by CHA2DS2-VASc score.Study participants were identified from Registry for Catastrophic Illness Patient Database. All cancer patients whether they had comorbid AF or not were divided into 4 groups according to their CHA2DS2-VASc score-a score of 0-1, 2-3, 4-5 and >5. Competing risk analysis was used to evaluate the subhazard ratios (SHRs) and 95% confidence intervals (CIs) of incident ischemic stroke between cancer patients with and without AF according to their CHA2DS2-VASc score.A total of 781473 patients with cancer were identified. Of them, 21134 had comorbid AF whereas the remaining 760339 patients did not. After controlling for the confounding factors and the competing risk of death, among cancer patients, those with AF were associated with the highest risk of ischemic stroke than those without AF while their CHA2DS2-VASc score was 0?1 (adjusted SHR [aSHR] = 4.15, 95% CI = 3.29-5.23). Among those with a CHA2DS2-VASc score of >5, the AF group exhibited a 1.82-fold higher risk of ischemic stroke than the non-AF group (95% CI = 1.34-2.47).The impact of AF on risk of ischemic stroke was attenuated with advancing CHA2DS2-VASc score in patients with cancer.

SUBMITTER: Hu WS

PROVIDER: S-EPMC5800930 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

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Impact of atrial fibrillation on the development of ischemic stroke among cancer patients classified by CHA<sub>2</sub>DS<sub>2</sub>-VASc score-a nationwide cohort study.

Hu Wei-Syun WS Lin Cheng-Li CL

Oncotarget 20180110 7

<h4>Purpose</h4>The current study aimed to explore the impact of atrial fibrillation (AF) on risk of ischemic stroke among cancer patients classified by CHA<sub>2</sub>DS<sub>2</sub>-VASc score.<h4>Methods</h4>Study participants were identified from Registry for Catastrophic Illness Patient Database. All cancer patients whether they had comorbid AF or not were divided into 4 groups according to their CHA<sub>2</sub>DS<sub>2</sub>-VASc score-a score of 0-1, 2-3, 4-5 and >5. Competing risk analysi ...[more]

PMID: 29484138

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Project description:BackgroundAtrial fibrillation (AF) is a common arrhythmia, and its most severe and dreaded complication is stroke. The CHA2DS2-VASc score is currently recommended for stroke risk assessment in AF. We aimed to explore the relationship between atrial FDG uptake and stroke and whether atrial FDG uptake could provide incremental value above the CHA2DS2-VAS score to predict stroke in AF by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT).Materials and methodsFrom September 2017 to December 2020, we retrospectively enrolled 230 patients (115 with AF and 115 without AF as the non-AF group, matched for the date of PET/CT examination and the basic characteristics of the patient) who underwent 18F-FDG PET/CT due to tumor screening or preoperative staging after prolonged fasting and followed up for at least 12 months from the date of PET/CT examination; the endpoint event is the occurrence of stroke. We visually and quantitatively analyzed 18F-FDG uptake in the right and left atria (RA/LA), right and left atrial appendage (RAA/LAA), right and left ventricle (RV/LV), and collected clinical features. In addition, according to the endpoint event (stroke), the enrolled population was divided into the stroke group and non-stroke group, and relevant clinical features and atrial FDG uptake indicators of the two groups were analyzed. Univariate and multivariate Cox regression analyzes were used to analyze the risk factors of stroke events. The Kaplan-Meier survival curve of atrial FDG uptake was drawn, and the log-rank method was used to compare the differences in the survival curves of the two groups. Receiver operating characteristic (ROC) curves were used to examine the discriminatory power of atrial FDG uptake in predicting stroke and determine whether the addition of atrial FDG uptake improves predictive value beyond the CHA2DS2-VASc score for stroke.ResultsIn the AF group, more than half of patients had RA FDG uptake and one-fifth had LA FDG uptake, while one patient had RA FDG uptake and two patients had LA FDG uptake in the non-AF group. In quantitative analysis, the maximum standardized uptake value (SUV max ) of the RA and LA in the AF group was significantly higher than that of the non-AF group (all P < 0.001). We followed up the patients for 28 ± 10 months, and finally, 31 patients had stroke. In the stroke group, atrial fibrillation, RA SUV max , RAA SUV max , LAA SUV max , age ≥ 75 years, and left atrial dilation were significantly higher than those of the non-stroke group (all P < 0.05). Multivariate Cox regression analysis showed that high RA SUV max (RA SUV max ≥ 2.62) was an independent risk factor for stroke (HR = 4.264, 95% CI 1.368-13.293, P = 0.012). By using the log-rank test, patients with high RA SUV max had a significantly higher incidence of stroke compared with patients with low RA SUV max (P < 0.001). Addition of high RA SUV max to the CHA2DS2-VASc score could predict stroke more effectively, with a larger AUC 0.790 (P < 0.001).ConclusionThis study found a significant correlation between atrial FDG uptake and AF, especially in RA. Meanwhile, RA FDG uptake is an independent risk factor for stroke, and patients with high RA SUV max have a significantly higher risk of stroke. Moreover, RA FDG uptake improves prediction of stroke above the CHA2DS2-VASc score in patients with AF.

Dataset Information

Impact of atrial fibrillation on the development of ischemic stroke among cancer patients classified by CHA2DS2-VASc score-a nationwide cohort study.

Publications

Impact of atrial fibrillation on the development of ischemic stroke among cancer patients classified by CHA<sub>2</sub>DS<sub>2</sub>-VASc score-a nationwide cohort study.

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