Impairment of Pulmonary Function is an Independent Risk Factor for Atrial Fibrillation: The Takahata Study

Background Patients with atrial fibrillation (AF) have an increased risk of ischaemic stroke. The risk can be predicted by the CHA2DS2-VASc score, in which the vascular component refers to previous myocardial infarction, peripheral artery disease and aortic plaque, whereas coronary artery disease (CAD) is not included. Objectives This article explores whether CAD per se or extent provides independent prognostic information of future stroke among patients with AF. Materials and Methods Consecutive patients with AF and coronary angiography performed between 2004 and 2012 were included. The endpoint was a composite of ischaemic stroke, transient ischaemic attack and systemic embolism. The risk of ischaemic events was estimated according to the presence and extent of CAD. Incidence rate ratios (IRR) were calculated in reference to patients without CAD and adjusted for parameters included in the CHA2DS2-VASc score and treatment with anti-platelet agents and/or oral anticoagulants. Results Of 96,430 patients undergoing coronary angiography, 12,690 had AF. Among patients with AF, 7,533 (59.4%) had CAD. Mean follow-up was 3 years. While presence of CAD was an independent risk factor for the composite endpoint (adjusted IRR, 1.25; 1.06–1.47), extent of CAD defined as 1-, 2-, 3- or diffuse vessel disease did not add additional independent risk information. Conclusion Presence, but not extent, of CAD was an independent risk factor of the composite thromboembolic endpoint beyond the components already included in the CHA2DS2-VASc score. Consequently, we suggest that significant angiographically proven CAD should be included in the vascular disease criterion in the CHA2DS2-VASc score.

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Abstract TP172: Pulmonary Function and White Matter Hyperintensity in Neurologically Healthy Adults

Stroke ◽

10.1161/str.48.suppl_1.tp172 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Han-Yeong Jeong ◽

Jin Ho Park ◽

Hyung-Min Kwon

Keyword(s):

Risk Factor ◽

White Matter ◽

Pulmonary Function ◽

Independent Risk Factor ◽

Small Vessel Disease ◽

Pulmonary Function Tests ◽

Cerebral Small Vessel Disease ◽

Healthy Adults ◽

White Matter Hyperintensity ◽

Vessel Disease

Introduction: Cerebral small vessel disease (SVD) is considered as precursor lesion of many clinical outcomes including stroke and dementia. It is well established that obstructive sleep apnea or chronic obstructive pulmonary disease is an independent risk factor of stroke. However, there are few studies about the association between pulmonary function and the presence of cerebral small vessel disease. Purpose: This study aims to investigate the association between pulmonary function and cerebral SVD in healthy adults. Methods: We conducted a cross-sectional study of 1,528 neurologically healthy people (mean age 56.0±9.0; 847 men), who underwent brain MRI and pulmonary function tests (forced vital capacity (FVC), forced expiratory volume in the first second (FEV 1 )). Risk factors, anthropometric parameters and clinical information were obtained. For evaluating cerebral SVD, the presence of small silent infarction (SSI) and the volume of white matter hyperintensity (WMH) were assessed through axial T2 fluid-attenuated inversion recovery (FLAIR) sequences MRI. Cerebral microbleeds (CMBs) were evaluated through T2-weighted gradient-recalled echo MRI. Results: The prevalence of SSI and CMBs were 9.6% (147 subjects) and 4.1% (63 subjects), respectively. The mean volume of WMH was 2.8±6.2mm 3 . In multiple regression analysis that controlled for age, sex, and smoking status, FVC had a significant negative correlation with WMH volume (R 2 =0.005, β=-0.109, p=0.002), and FEV 1 /FVC ratio had a significant correlation with WMH volume (R 2 =0.006, β=0.083, p=<0.001). In multivariable logistic analysis, after adjusting age, gender, hypertension, and glucose, FVC was negatively associated with the presence of SSI (adjusted OR 0.63, 95% CI 0.44-0.91), and FEV 1 /FVC ratio was positively associated with the presence of SSI (adjusted OR 1.05, 95% CI 1.02-1.08). The presence of CMBs was not associated with any factor of pulmonary function tests. Conclusions: The results from our study suggest that lower pulmonary function, especially FVC, was found to be an independent risk factor of cerebral SVD in neurologically healthy adults.

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