CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 3, September – October 2024 AFRICA 137 specificity of 65.7%, area under the curve (AUC) of 0.833 with 95% CI (0.792–0.874) (Fig. 3). Patients with CHA2DS2-VASc score ≥ 2 were 7.366-fold (95% CI: 3.452–15.722) more likely to develop AVS compared with those who had a CHA2DS2-VASc score < 2 (Table 2). In the univariate logistic regression analysis, CHA2DS2-VASc score ≥ 2, FBG, HDL-C, LVEF, LVEDD, PWT, IVST, LAD, ascending aortic diameter, eGFR, WBC, neutrophil, insulin and statin therapies were found to be predictors of AVS. Moreover, we determined that CHA2DS2-VASc score ≥ 2, LVEF and ascending aortic diameter were independent predictors of AVS (Table 2). Median CHA2DS2-VASc scores among the AVS grades are shown in Fig. 4. We determined that median CHA2DS2-VASc scores showed a significant difference according to AVS grade [grade 0, n = 102, 1 (0–4); grade 1, n = 100, 3 (0–7); grade 2, n = 134, 3 (0–7); grade 3, n = 177, 4 (1–8), H (3) = 160,935, p < 0.001), respectively]. Median CHA2DS2-VASc scores of grades 0 and 1 and grades 2 and 3 were significantly different. On the other hand, median CHA2DS2-VASc scores of grades 1 and 2 were similar [1 (0–4) vs 3 (0–7), p = 0.001; 3 (0–7) vs 4 (1–8), p = 0.001, 3 (0–7) vs 3 (0–7), p = 0.26, respectively]. Also, to investigate whether AVS grade correlated with CHA2DS2-VASc score, Spearman correlation analysis was performed. A positive correlation was determined between AVS grade and CHA2DS2VASc score (r = 0.548, p < 0.001). Discussion The results of our study indicate three main findings: first, CHA2DS2-VASc ≥ 2 score was independently associated with AVS; second, the cut-off point of the CHA2DS2-VASc score to predict AVS was ≥ 2; finally, there was a positive correlation between the grade of AVS and the CHA2DS2-VASc score. The CHA2DS2-VASc score was initially designed for predicting embolic events and adjusting antithrombotic therapy in AF patients. This score drew attention because it included many CV risk factors together, and several studies encompassed it in different clinical settings. The CHA2DS2-VASc score was found to have predictive value both in acute and chronic coronary syndromes.2,3 Recently, Shang et al. detected a correlation between the CHA2DS2-VASc score and carotid plaques, known as a marker of subclinical atherosclerosis. Similarly, we determined an association between CHA2DS2-VASc score and AVS, a H(3) = 160.935, p < 0.001 n = 102 1 (0–4) n = 100 3 (0–7) n = 134 3 (0–7) n = 177 4 (1–8) CHA2DS2–VASc score Aortic valve sclerosis grade 0 1 2 3 8 6 4 2 0 Fig. 4. Median CHA2DS2-VASc scores according to AVS grades. Median CHA2DS2-VASc scores of AVS grades were compared with the Kruskal–Wallis H-test. Sensitivity AUC: 0.833; 95% CI: 0.792–0.874 Sensitivity: 81.2%; Specifity: 65.7% 0.0 0.2 0.4 0.6 0.8 1.0 1.0 0.8 0.6 0.4 0.2 0.0 1 – Specificity Fig. 3. ROC curves for CHA2DS2VASc score in order to evaluate AVS. The area under the ROC curve was utilised to figure out cut-off points of different CHA2DS2-VASc scores in AVS patients. Table 2. Odds ratio and 95% CI between the CHA2DS2VASc score and prevalence of AVS Univariate Multivariate Variables Odds ratio (95% Cl) p-value Odds ratio (95% CI) p-value CHA2DS2VASc ≥ 2 12.976 (7.684– 21.916) < 0.001 7.366 (3.452–15.722) < 0.001 FBG 1.011 (1.004–1.018) 0.004 0.995 (0.987–1.003) 0.251 TC 0.995 (0.99–1) 0.042 0.996 (0.977–1.017) 0.729 TG 1.001 (0.999–1.004) 0.294 HDL-C 0.976 (0.959–0.994) 0.008 1.012 (0.983–1.042) 0.414 LDL-C 0.994 (0.988–1) 0.039 1.003 (0.981–1.026) 0.763 LVEF 0.846 (0.8–0.893) 0.000 0.873 (0.816–0.934) < 0.001 LVEDD 2.196 (1.265–3.814) 0.005 0.493 (0.186–1.309) 0.156 IVST 74.842 (14.038–399.011) < 0.001 3.515 (0.121–102.031) 0.465 PWT 23.448 (4.783–114.954) < 0.001 7.209 (0.419–124.018) 0.174 LVDD 3.524 (2.250–5.521) < 0.001 0.943 (0.491–1.814) 0.861 LAD 5.488 (2.807–10.73) < 0.001 1.162 (0.408–3.308) 0.779 Asc. aorta dia. 3.798 (1.904–7.575) < 0.001 4.697 (1.758–12.549) 0.002 eGFR 0.97 (0.955–0.985) < 0.001 1.006 (0.985–1.027) 0.563 WBC 1.199 (1.044–1.378) 0.010 0.784 (0.525–1.171) 0.234 Neutrophils 1.432 (1.179–1.738) < 0.001 1.682 (0.993–2.85) 0.053 Insulin therapy 14.846 (2.028–108.688) 0.008 12.926 (1.246–134.103) 0.032 Statin therapy 3.952 (2.334–6.691) < 0.001 1.814 (0.918–3.582) 0.087 Asc. aorta dia: ascending aorta diameter, FBG: fasting blood glucose, eGFR: estimated glomerular filtration rate, HDL-C: high-density lipoprotein cholesterol, LAD: left atrial diameter, LDL-C: low-density lipoprotein cholesterol, LVDD: left ventricular diastolic dysfunction, LVEDD: left ventricular enddiastolic diameter, LVEF: left ventricular ejection fraction, IVST: interventricular septal thickness, OR: odds ratio, PWT: posterior wall thickness, TC: total cholesterol, TG: triglyceride, WBC: white blood cells.
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