CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 3, September – October 2024 136 AFRICA summarised as means ± standard deviation (SD) and were compared by t-test analysis. We used the Pearson chi-squared test to compare categorical data and the Mann–Whitney U-test for non-parametric analysis. Univariate and multivariate logistic regression was also used to assess the association between AVS and CHA2DS2-VASc scores. Fasting blood glucose (FBG), eGFR, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) levels; white blood cell (WBC) and neutrophil counts; PWT, IVST, LVEDD, LVDD, LAD, ascending aortic diameter, LVEF, insulin and statin therapies were adjusted in the multivariate logistic regression analysis. We used the area under the receiver operating characteristic (ROC) curve to determine the cut-off points of different CHA2DS2VASc scores in AVS patients. All tests were two-tailed and a p-value < 0.05 was considered statistically significant. Median CHA2DS2-VASc scores of AVS grades were compared with the Kruskal–Wallis H-test. The Spearman correlation test was used for the correlation of AVS grade and CHA2DS2-VASc score. Results We analysed 513 patients who underwent TTE because of different clinical indications [AVS grade 0, 102 (19.9%); AVS grade 1, 100 (19.5%); AVS grade 2, 134 (26.1%); AVS grade 3, 177 (34,5%)]. We divided patients into two groups according to detection of AVS (AVS grade 1–3) or not (AVS grade 0) (n = 411, 38.2% female, age 63.52 ± 7.24 years vs n = 102, 38.2% female; age 62.03 ± 5.26 years). The demographic and clinical data of participants are presented in Table 1. CHA2DS2-VASc scores of the study population and groups are shown in Fig. 2. We determined that the AVS (+) group had a higher prevalence of CAD, stroke and peripheral artery disease (PAD) than the AVS (–) group (54.3 vs 13.7%; 11.9 vs 0%; 22.9 vs 2.9%, respectively, all p values < 0.001). We also determined that the patients in the AVS (+) group were older and had higher CHA2DS2-VASc scores (63.52 ± 7.24 vs 62.03 ± 5.26 years, p = 0.012; 3 (0–8) vs 1 (0–4), p < 0.001, respectively). When we analysed TTE findings, we found that the AVS (+) group patients had lower LVEF and higher IVST, LAD and ascending aorta measurements when compared to the AVS (–) group (52.64 ± 10.76 vs 59.96 ± 4.55; 1.13 ± 0.14 vs 1.06 ± 0.11; 3.87 ± 0.45 vs 3.64 ± 0.3; 3.68 ± 1.73 vs 3.46 ± 0.29, respectively, all p-values < 0.001). LVDD was more common in the AVS (+) group than in the AVS (–) group (40.2 vs 70.3%, p < 0.001). We determined that oral antidiabetic (OAD) use, insulin and statin treatment rates were higher in the AVS (+) group than in the AVS (–) group (29.7 vs 11.7%, p = 0.001; 48.9 vs 19.6%, p < 0.001; 48.9 vs 19.6%, p < 0.001, respectively). A cut-off value of ≥ 2 for the CHA2DS2-VASc score was estimated to evaluate AVS, which had a sensitivity of 81.2% and Table 1. Demographic and clinical data according to AVS Demographics AVS (–), n = 102 AVS (+), n = 411 p-value Age, year 62.03 ± 5.26 63.52 ± 7.24 0.012 Gender, female, n (%) 39 (38.2) 157 (38.2) 0.995 Co-morbidities, n (%) DM 15 (14.7) 181 (44) < 0.001 HT 54 (52.9) 382 (92.9) < 0.001 CAD 14 (13.7) 223 (54.3) < 0.001 CHF 1 (1) 97 (23.6) < 0.001 Laboratory findings FBG, mg/dl (mmol/l) 101.69 ± 27.82 5.64 ± 1.54 119.65 ± 55.97 6.64 ± 3.11 0.024 Creatinine, mg/dl 0.82 ± 0.16 0.94 ± 0.31 0.001 TC, mg/l (mmol/l) 194.04 ± 44 5.03 ± 1.14 184.37 ± 45.84 4.78 ± 1.19 0.038 TG, mg/l (mmol/l) 162.86 ± 73.67 1.84 ± 0.83 174.18 ± 107.23 1.97 ± 1.21 0.646 HDL-C, mg/l (mmol/l) 47.28 ± 13 1.22 ± 0.34 43.23 ± 12.24 1.12 ± 0.32 0.012 LDL-C, mg/l (mmol/l) 114.1 ± 37.54 2.96 ± 0.97 107.3 ± 37.49 2.78 ± 0.97 0.043 WBC, × 103 cells/µl 6.98 ± 1.38 7.51 ± 1.79 0.035 Hb, g/dl 14.21 ± 1.47 13.71 ± 1.7 0.011 Plt, × 103 cells/µl 253.29 ± 59.07 267.44 ± 76.01 0.141 Echocardiographic findings LVEDD, cm 4.64 ± 0.36 4.80 ± 0.54 0.032 LVEF, % 59.96 ± 4.55 52.64 ± 10.76 < 0.001 PWT, cm 1.02 ± 0.1 1.08 ± 0.15 < 0.001 Aortic velocity, m/s 1.2 (1.0–1.9) 1.3 (1.0–1.9) 0.478 Ascending aorta diameter 3.46 ± 0.29 3.68 ± 1.73 < 0.001 LVDD, n (%) 41 (40.2) 289 (70.3) < 0.001 CHA2DS2VASc score 1 (0–4) 3 (0–8) < 0.001 CHA2DS2VASc ≥ 2 47 (46.0) 377 (91.7) < 0.001 Drugs, n (%) ASA 34 (33.3) 251 (61.0) < 0.001 Beta-blocker 25 (24.5) 269 (65.4) < 0.001 ACE inhibitor 22 (21.5) 154 (37.4) 0.002 Statin 20 (19.6) 201 (48.9) < 0.001 OAD 12 (11.7) 115 (27.9) 0.001 Insulin 1 (0.9) 53 (12.8) < 0.001 ACE: angiotensin converting enzyme, ASA: acetylsalicylic acid, AVS: aortic valve sclerosis, CAD: coronary artery disease, CHF: congestive heart failure, DM: diabetes mellitus, FBG: fasting blood glucose, Hb: haemoglobin, HDL-C: high-density lipoprotein cholesterol, HT: hypertension, LDL-C: low-density lipoprotein cholesterol, LVDD: left ventricular diastolic dysfunction, LVEDD: left ventricular end-diastolic diameter, LVEF: left ventricular ejection fraction, OAD: oral antidiabetic, Plt: platelets, PWT: posterior wall thickness, TC: total cholesterol, TG: triglyceride, WBC: white blood cells. 0 1 2 3 4 5 6 Frequency 120 100 80 60 40 20 0 CHA2DS2-VASc score 0 1 2 3 4 Frequency 40 30 20 10 0 CHA2DS2-VASc score 0 1 2 3 4 5 6 Frequency 120 100 80 60 40 20 0 CHA2DS2-VASc score Fig. 2. CHA2DS2-VASc scores (A) in the study population, (B) in the AVS (–) group and (C) in the AVS (+) group. A B C
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