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

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.