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CHA2DS2-VASc Score Predicts Adverse Outcome in Patients with Simple Congenital Heart Disease Regardless of Cardiac Rhythm

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Abstract

Adult patients with simple congenital heart disease (sACHD) represent an expanding population vulnerable to atrial arrhythmias (AA). CHA2DS2-VASc score estimates thromboembolic risk in non-valvular atrial fibrillation patients. We investigated the prognostic role of CHA2DS2-VASc score in a non-selected sACHD population regardless of cardiac rhythm. Between November 2009 and June 2018, 427 sACHD patients (377 in sinus rhythm, 50 in AA) were consecutively referred to our ACHD service. Cardiovascular hospitalization and/or all-cause death were considered as composite primary end-point. Patients were divided into group A with CHA2DS2-VASc score = 0 or 1 point, and group B with a score greater than 1 point. Group B included 197 patients (46%) who were older with larger prevalence of cardiovascular risk factors than group A. During a mean follow-up of 70 months (IQR 40–93), primary end-point occurred in 94 patients (22%): 72 (37%) in group B and 22 (10%, p < 0.001) in group A. Rate of death for all causes was also significantly higher in the group B than A (22% vs 2%, respectively, p < 0.001). Multivariable Cox regression analysis revealed that CHA2DS2-VASc score was independently related to the primary end-point (HR 1.84 [1.22–2.77], p = 0.004) together with retrospective AA, stroke/TIA/peripheral thromboembolism and diabetes. Furthermore, CHA2DS2-VASc score independently predicted primary end-point in the large subgroup of 377 patients with sinus rhythm (HR 2.79 [1.54–5.07], p = 0.01). In conclusion, CHA2DS2-VASc score accurately stratifies sACHD patients with different risk for adverse clinical events in the long term regardless of cardiac rhythm.

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Authors and Affiliations

  1. Azienda Sanitaria Universitaria Integrata di Trieste, Via Slataper n°9, 34134, Trieste, Italy

    Giorgio Faganello, Giulia Russo, Carmine Mazzone, Gianfranco Sinagra & Andrea Di Lenarda

  2. Dipartimento di Scienze Mediche e Chirurgiche e della Salute, Università degli Studi di Trieste, Trieste, Italy

    Giulia Barbati, Arjuna Scagnetto & Michele Zaccari

  3. IRCCS materno infantile Burlo Garofolo, Trieste, Italy

    Biancamaria D.’Agata Mottolese

  4. Scuola di Medicina e Chirurgia, Università degli Studi di Verona, Verona, Italy

    Giovanni Cioffi

Authors
  1. Giorgio Faganello
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  2. Giulia Barbati
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  3. Giulia Russo
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  4. Arjuna Scagnetto
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  5. Carmine Mazzone
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  6. Biancamaria D.’Agata Mottolese
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  7. Michele Zaccari
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  8. Gianfranco Sinagra
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  9. Andrea Di Lenarda
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  10. Giovanni Cioffi
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Contributions

GF contributed to the conception, design of the work and writing the manuscript. GC contributed to the data analysis and critical review of the manuscript. GB and AS contributed to the data analysis and the drafting of the manuscript. GR, CM, MZ and BAM contributed to the data acquisition. ADL and GS contributed to the data interpretation and critical review of the manuscript. All authors gave final approval and agree to be accountable for all aspects of work ensuring integrity and accuracy.

Corresponding author

Correspondence to Giorgio Faganello.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies involving human and animal participants performed by any of the authors.

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Informed consent, either from patients or parents, was legibly obtained according to the institution policy in whom interventional procedures were performed and who were included in the study.

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Faganello, G., Barbati, G., Russo, G. et al. CHA2DS2-VASc Score Predicts Adverse Outcome in Patients with Simple Congenital Heart Disease Regardless of Cardiac Rhythm. Pediatr Cardiol 41, 1051–1057 (2020). https://doi.org/10.1007/s00246-020-02356-5

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  • DOI: https://doi.org/10.1007/s00246-020-02356-5

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