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Abstract: Background: The CHADS2 score is a stroke risk stratification system for patients with atrial fibrillation (AF). The relationship between the pre-admission CHADS2 score and stroke severity or outcome was examined in AF-related cardioembolic stroke patients. Methods: 423 consecutive AF-related cardioembolic stroke patients (250 men, 173 women; aged 76±10years) were reviewed. Results: Pre-admission CHADS2 scores of 0, 1, 2, 3, 4, 5, and 6 were present in 4.3%, 21.0%, 34.3%, 23.6%, 11.8%, 4.5%, and 0.5% of patients, respectively. There were significant correlations (P<0.001) between CHADS2 and National Institutes of Health Stroke Scale (NIHSS) scores on admission, and CHADS2 and modified Rankin scale (mRS) scores at discharge. The optimal cutoff CHADS2 score for an mRS score ≥3 was ≥2 (sensitivity 84%, specificity 38%). For death, the optimal cutoff CHADS2 score was ≥3 (sensitivity 59%, specificity 62%). On multivariate analysis, a CHADS2 score ≥2 was independently associated with an mRS score ≥3 (OR 1.93, 95% CI 1.39–2.72, P<0.001), and a CHADS2 score ≥3 was independently associated with death (OR 1.46, 95% CI 1.02–2.11, P=0.038). Conclusions: The CHADS2 score is related to severity and outcomes of stroke in patients with AF. [Copyright &y& Elsevier]

Abstract: Background: Although several risk factors for stroke have been reported in patients with atrial fibrillation (AF), the relation of LV diastolic dysfunction to stroke is still uncertain in these patients. We evaluated the relationship between tissue Doppler-derived index, E/E'', as well as other clinical and echocardiographic parameters and ischemic stroke by this cross-sectional study. Methods: Three hundred thirty patients with persistent AF who had preserved LV ejection fraction were included from 6 centers. Clinical data were obtained and standard transthoracic echocardiography was performed. Patients without a history of ischemic stroke (n =280) were compared with patients with this complication (n =50). Potential determinants of ischemic stroke were identified by logistic regression analyses. Results: In univariate analyses, age, history of hypertension, diabetes mellitus, hyperlipidemia and symptomatic heart failure, plasma brain natriuretic peptide (BNP) level, early mitral inflow velocity (E), diastolic mitral annular velocity (E''), and E/E'' ratio were significantly correlated to ischemic stroke. Multivariate regression analyses identified two significant variables that were independently associated with ischemic stroke: hypertension (odds ratio=6.03, p =0.008), and E/E'' (odds ratio=1.21, p =0.002). Conclusions: These findings may have clinical implications that LV diastolic dysfunction, reflected by E/E'', is a significant determinant of ischemic stroke in AF. A larger prospective data is needed to confirm the value of E/E'' in risk stratification for ischemic stroke in this population. [Copyright &y& Elsevier]

Abstract: Background and purpose: Congestive heart failure is a risk factor for ischemic stroke. Brain natriuretic peptide (BNP) is used as a biological marker of heart failure. We hypothesized that heart failure was associated with the onset of ischemic stroke patients with atrial fibrillation (AF). Methods: Between June 2006 and December 2007, we prospectively enrolled consecutive acute ischemic stroke patients with AF within 24 h of onset. Plasma BNP was measured twice, on admission and on days 28 or at discharge. As a control, we measured plasma BNP of chronic phase of stroke outpatients with AF. We investigated whether plasma BNP was elevated in the acute phase of stroke. Results: One hundred and nine patients (58 females; mean age, 76.3 years) were enrolled in the present study. Mean±SD of NIHSS score on admission and mRS score at discharge were 12.6±8.3 and 3.7±1.8, respectively. The interval from stroke onset to plasma BNP measurement on admission was 6.8±6.3 h. Moreover, follow up BNP was measured at mean of 26±9 days after stroke onset. The plasma BNP level in the acute phase of stroke was significantly higher than that of the subacute phase of stroke (median (interquartile range, IQR) 299.0 (176.8–469.5) vs. 149.5 (68.1–347.0) pg/ml, p <0.001). There was no significant difference in plasma BNP level between the subacute phase of stroke and control group (median (IQR) 149.5 (68.1–347.0) vs. 165.0 (64.6–224.0) pg/ml, p =0.543). Conclusion: Plasma BNP was elevated in the acute phase of stroke. Heart failure may be associated with the onset of ischemic stroke patients with AF. [Copyright &y& Elsevier]