CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 3, September – October 2024 134 AFRICA Cardiovascular Topics The association between CHA2DS2-VASc score and aortic valve sclerosis Funda Başyiğit, Havva Tuğba Gürsoy, Özlem Özcan Çelebi, Kevser Gülcihan Balcı, Özgül Uçar Elalmış, Kerem Özbek, Özge Çakmak Karaaslan, Mehmet İleri, Telat Keleş, Sinan Aydoğdu Abstract Background: Antithrombotic therapy in atrial fibrillation is generally managed with the CHA2DS2-VASc score. Aortic valve sclerosis (AVS) is a focal thickening of the aortic valve without a restriction of motion. AVS is related to several cardiovascular risk factors. Our study was performed to evaluate whether the presence of AVS was associated with the CHA2DS2-VASc score. Methods: This cross-sectional, observational study comprised 411 patients with AVS grades 1–3 [AVS (+)] and 102 patients with AVS grade 0 [AVS (–)]. We compared CHA2DS2-VASc scores between the AVS (+) and AVS (–) groups. Results: We determined that the AVS (+) group had a higher CHA2DS2-VASc score than the AVS (–) group [3 (0–8) vs 1 (0–4), p < 0.001)]. Conclusion: In our study, the CHA2DS2-VASc score was found to be higher in patients with AVS than in those without AVS. AVS may predict cardiovascular risk in the general population. Keywords: aortic valve, atherosclerosis, coronary artery disease, inflammation Submitted 17/2/22; accepted 12/4/23 Published online 26/7/23 Cardiovasc J Afr 2024; 35: 134–139 www.cvja.co.za DOI: 10.5830/CVJA-2023-022 The CHADS2 and CHA2DS2-VASc scores are widely used to estimate stroke risk and guide antithrombotic therapy in patients with atrial fibrillation (AF).1 Recent studies have shown that CHADS2 and CHA2DS2-VASc scores, incorporating several cardiovascular (CV) risk factors, can also be helpful in different clinical situations besides AF. These scores have been demonstrated to have predictive values in terms of death in patients with stable coronary artery disease (CAD) and acute coronary syndromes.2,3 CHA2DS2-VASc, the updated version of CHADS2, contains seven clinical variables, several of which are also CV risk factors, including congestive heart failure (CHF), hypertension (HT), age ≥ 75 years, diabetes mellitus (DM), stroke/transient ischaemic event, vascular disease, age 65 to 74 years and gender category (female). Kim et al. indicated in their study that higher CHA2DS2-VASc scores had worse CV outcomes in acute myocardial infarction patients.3 Also recently, Shang et al. reported a correlation between the CHA2DS2-VASc score and the prevalence of carotid plaques.4 Aortic valve sclerosis (AVS) can be described by focal areas of thickening of the leaflets without a restriction of motion, with a peak velocity of less than 2.0 m/s.5 It can easily be detected by transthoracic echocardiography (TTE), a safe, inexpensive and widely used imaging method. In the past, it was believed that AVS was a degenerative disease associated with aging. However, the absence of AVS in approximately 50% of individuals above the age of 80 years suggested that different mechanisms play a role in its aetiology.6 Today it is clear that AVS is not only simply a degenerative process but it also represents a complex process involving lipoprotein deposition, chronic inflammation and activation of the calcification cascade, similar to atherosclerosis. Several studies have shown a relationship between atherosclerosis and AVS.6-9 Although a direct connection has not been established, available data suggest that most components of the CHA2DS2-VASc score are also potential risk factors for atherosclerosis.10 Therefore, a hypothesis that the CHA 2DS2VASc score may be associated with AVS seems plausible. The correlation between the overall CHA2DS2-VASc score and AVS has not yet been studied. Based on this knowledge, we sought to design a cross-sectional study to search the relationship between the overall CHA2DS2-VASc score and AVS in patients without AF. Methods This was a single-centre, cross-sectional and observational study designed with patients aged > 18 and ≤ 75 years. We included 513 patients consecutively who had undergone TTE due to various clinical indications in the Ankara City Hospital cardiology clinic between March and December 2021. Department of Cardiology, Ankara City Hospital, Ankara, Turkey Funda Başyiğit, MD, ftuna02@yahoo.com Havva Tuğba Gürsoy, MD Özlem Özcan Çelebi, MD Kevser Gülcihan Balcı, MD Özgül Uçar Elalmış, MD Kerem Özbek, MD Özge Çakmak Karaaslan, MD Mehmet İleri, MD Telat Keleş, MD Sinan Aydoğdu, MD
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