CHA2DS2-VASc评分与心房颤动患者主动脉钙化的相关性及性别特异性预测价值

Association between CHA2DS2-VASc score and aortic calcification in patients with atrial fibrillation and its sex-specific predictive value

摘要:

背景与目的 主动脉钙化是心血管不良事件及主动脉疾病的重要危险因素，但其在心房颤动（AF）患者中的风险评估工具仍有限。CHA₂DS₂-VASc评分广泛用于AF患者卒中风险评估，其与主动脉钙化之间的关系尚未明确。本研究探讨CHA₂DS₂-VASc评分与AF患者主动脉钙化的相关性及其预测价值。方法 回顾性纳入2015年2月—2022年2月在中南大学湘雅三医院接受胸部非增强多层螺旋CT（MSCT）检查的AF患者1 538例。依据MSCT结果将患者分为主动脉钙化组和非钙化组。采用受试者工作特征（ROC）曲线分析CHA₂DS₂-VASc评分预测主动脉钙化的最佳截断值；采用多因素Logistic回归模型分析CHA₂DS₂-VASc评分与主动脉钙化的独立相关性。结果 共1 251例（81.3%）患者存在主动脉钙化。钙化组年龄及高血压、糖尿病、冠心病、脑梗死、心力衰竭等危险因素发生率均高于非钙化组（均P<0.05），CHA₂DS₂-VASc评分亦明显增加［3.0（2.0~4.0）vs. 1.0（0~2.0），P<0.001］。随着CHA₂DS₂-VASc评分增加，主动脉钙化患病率逐渐升高（P_趋势<0.001）。ROC曲线分析显示，男性患者预测主动脉钙化的最佳截断值为评分2（AUC=0.737，95% CI=0.697~0.776），女性患者为评分3（AUC=0.730，95% CI=0.673~0.787）。多因素Logistic回归分析显示，CHA₂DS₂-VASc评分每增加1分，主动脉钙化风险增加91.2%（OR=1.912，95% CI=1.638~2.232，P<0.001）。男性评分≥2（OR=5.528，95% CI=3.240~9.434）及女性评分≥3（OR=9.295，95% CI=4.390~19.681）均为主动脉钙化的独立危险因素（均P<0.001）。结论 CHA₂DS₂-VASc评分与AF患者主动脉钙化风险密切相关，且具有良好的预测能力。男性≥2、女性≥3可作为识别主动脉钙化高风险人群的参考界值，为AF患者血管病变风险分层提供简便工具。

Abstract:

Background and Aims Aortic calcification is an important risk factor for adverse cardiovascular outcomes and aortic diseases. However, effective tools for assessing the risk of aortic calcification in patients with atrial fibrillation (AF) remain limited. The CHA₂DS₂-VASc score is widely used for stroke risk stratification in AF, but its association with aortic calcification has not been fully elucidated. This study aimed to investigate the relationship between the CHA₂DS₂-VASc score and aortic calcification and to evaluate its predictive value in patients with AF.Methods A total of 1 538 patients with AF who underwent multi-slice computed tomography (MSCT) at the Third Xiangya Hospital, Central South University between February 2015 and February 2022 were retrospectively included. Patients were classified into aortic calcification and non-calcification groups according to MSCT findings. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off values of the CHA₂DS₂-VASc score for predicting aortic calcification. Multivariable logistic regression analysis was used to evaluate the independent association between the CHA₂DS₂-VASc score and aortic calcification.Results Aortic calcification was identified in 1 251 patients (81.3%). Compared with the non-calcification group, patients with aortic calcification were older and had higher prevalences of hypertension, diabetes mellitus, coronary artery disease, cerebral infarction, and heart failure (all P<0.05). The CHA₂DS₂-VASc score was significantly higher in the calcification group [3.0 (2.0-4.0) vs. 1.0 (0-2.0), P<0.001]. The prevalence of aortic calcification increased progressively with increasing CHA₂DS₂-VASc scores (P for trend <0.001). ROC analysis demonstrated that the optimal cut-off value was 2 points in men (AUC=0.737, 95% CI=0.697-0.776) and 3 points in women (AUC=0.730, 95% CI=0.673-0.787). Multivariable logistic regression showed that each 1-point increase in the CHA₂DS₂-VASc score was independently associated with a higher risk of aortic calcification (OR=1.912, 95% CI=1.638-2.232, P<0.001). Male patients with a score ≥2 and female patients with a score ≥3 had significantly increased risks of aortic calcification [OR=5.528 (95% CI=3.240-9.434) and 9.295 (95% CI=4.390-19.681), respectively; both P<0.001].Conclusion The CHA₂DS₂-VASc score is significantly associated with the risk of aortic calcification in patients with AF and demonstrates good predictive performance. Sex-specific thresholds of ≥2 for men and ≥3 for women may facilitate risk stratification and early identification of patients at high risk for aortic calcification.