Hypertension and Abnormal Renal Function and the Risk of Ischaemic Stroke in Anticoagulated Type 1 Evaluated Heart Valves, Rheumatic or Artificial Valvular AF

Abstract

Background: AF substantially increases the risk of stroke. The most widely used risk prediction score for AF is CHA2DS2-VASC. Previous studies have mainly focused on its efficacy among patients with non-valvular AF. The few studies that have considered patients with valvular AF highlight the tool’s poor scoring accuracy. Objective: This study was conducted to evaluate the clinical factors and echocardiographic parameters related to the incidence of ischaemic stroke in anticoagulated evaluated heart valves, rheumatic or artificial (EHRA) type 1 valvular AF patients. Methods: We conducted a retrospective cohort study using data from the Indonesian Registry on Atrial Fibrillation (OneAF). Patients with EHRA type 1 valvular AF recorded in the registry from January 2015 to December 2019 were included in the study. Results: The incidence of ischaemic stroke was 17 (5.2%) out of 329 AF patients with mitral stenosis or mechanical prosthetic valves. A multivariate analysis showed that two clinical factors: hypertension (OR 5.59; 95% CI [1.93–16.15]; p=0.001) and estimated glomerular filtration rate (eGFR) ≤59 ml/min/m2 (OR 3.62; 95% CI [1.30–10.02]; p=0.013), were independently associated with the incidence of ischaemic stroke. No echocardiographic parameters were associated with the incidence of ischaemic stroke in this population. Conclusion: Hypertension and impaired renal function elevated the risk of ischaemic stroke in the patient population. Further research is necessary to determine the proper scoring system for predicting ischaemic stroke in this subgroup.