Erdi Babayiğit MD, Gurbet Özge Mert MD, Bülent Görenek MD, FACC, FESC
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On the other hand, it has been reported that atrial fibrillation (AF) is observed in 24% of all strokes and 12% in non-fatal strokes (Akyea et al., <span>2021</span>; Tsao et al., <span>2022</span>). Considering the retrospective nature of the study and the fact that two patients were even on anticoagulants, it may be difficult to say exactly how many of the patients who reached the primary outcome were guilty of AF.</p><p>Another point, the fact that patients with left ventricular end diastolic diameter of 46 mm and above were not evaluated in terms of heart failure with preserved ejection fraction (HFpEF) seems to be the limitation of the study. It is possible that the CHA<sub>2</sub>DS<sub>2</sub>-VASc score was calculated as 0 even though some patients had heart failure, ignoring the fact that the incidence of heart failure is approximately 1% especially under the age of 55, the lack of natriuretic peptide evaluation and the threshold for the resting E/e’ ratio is 9 in HFpEF diagnosis (McDonagh et al., <span>2021</span>).</p><p>Finally, we would like to draw attention to obesity that is important in the development of AF and stroke and systemic embolism, as the mean weight was almost close to overweight range in the study. We also have seen that age is actually an important predictor in terms of shedding light on future studies on the prediction of outcomes.</p><p>The article was prepared with the contributions of all authors.</p><p>None.</p>","PeriodicalId":8074,"journal":{"name":"Annals of Noninvasive Electrocardiology","volume":"28 3","pages":""},"PeriodicalIF":1.1000,"publicationDate":"2023-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/anec.13060","citationCount":"0","resultStr":"{\"title\":\"Stroke and systemic embolism risk in patients with CHA2DS2-VASc score of 0\",\"authors\":\"Erdi Babayiğit MD, Gurbet Özge Mert MD, Bülent Görenek MD, FACC, FESC\",\"doi\":\"10.1111/anec.13060\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p>Dear Editor,</p><p>We have read with great interest the article published in your journal titled “Predictors of stroke or systemic embolism in patients with non-valvular atrial fibrillation with CHA<sub>2</sub>DS<sub>2</sub>-VASc score of 0” by Choi et al. (<span>2023</span>). The authors evaluated the predictors of atrial fibrillation in patients with CHA<sub>2</sub>DS<sub>2</sub>-VASc score of 0. We would like to draw attention to a few points about this article.</p><p>The major finding of the study was that risk of stroke or embolism rate was very low. Interestingly, the most of the patients were followed up without anticoagulation and no stroke was observed. We believe that especially the short follow-up period has shown a significantly lower risk of stroke in the study. On the other hand, it has been reported that atrial fibrillation (AF) is observed in 24% of all strokes and 12% in non-fatal strokes (Akyea et al., <span>2021</span>; Tsao et al., <span>2022</span>). Considering the retrospective nature of the study and the fact that two patients were even on anticoagulants, it may be difficult to say exactly how many of the patients who reached the primary outcome were guilty of AF.</p><p>Another point, the fact that patients with left ventricular end diastolic diameter of 46 mm and above were not evaluated in terms of heart failure with preserved ejection fraction (HFpEF) seems to be the limitation of the study. It is possible that the CHA<sub>2</sub>DS<sub>2</sub>-VASc score was calculated as 0 even though some patients had heart failure, ignoring the fact that the incidence of heart failure is approximately 1% especially under the age of 55, the lack of natriuretic peptide evaluation and the threshold for the resting E/e’ ratio is 9 in HFpEF diagnosis (McDonagh et al., <span>2021</span>).</p><p>Finally, we would like to draw attention to obesity that is important in the development of AF and stroke and systemic embolism, as the mean weight was almost close to overweight range in the study. 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Stroke and systemic embolism risk in patients with CHA2DS2-VASc score of 0
Dear Editor,
We have read with great interest the article published in your journal titled “Predictors of stroke or systemic embolism in patients with non-valvular atrial fibrillation with CHA2DS2-VASc score of 0” by Choi et al. (2023). The authors evaluated the predictors of atrial fibrillation in patients with CHA2DS2-VASc score of 0. We would like to draw attention to a few points about this article.
The major finding of the study was that risk of stroke or embolism rate was very low. Interestingly, the most of the patients were followed up without anticoagulation and no stroke was observed. We believe that especially the short follow-up period has shown a significantly lower risk of stroke in the study. On the other hand, it has been reported that atrial fibrillation (AF) is observed in 24% of all strokes and 12% in non-fatal strokes (Akyea et al., 2021; Tsao et al., 2022). Considering the retrospective nature of the study and the fact that two patients were even on anticoagulants, it may be difficult to say exactly how many of the patients who reached the primary outcome were guilty of AF.
Another point, the fact that patients with left ventricular end diastolic diameter of 46 mm and above were not evaluated in terms of heart failure with preserved ejection fraction (HFpEF) seems to be the limitation of the study. It is possible that the CHA2DS2-VASc score was calculated as 0 even though some patients had heart failure, ignoring the fact that the incidence of heart failure is approximately 1% especially under the age of 55, the lack of natriuretic peptide evaluation and the threshold for the resting E/e’ ratio is 9 in HFpEF diagnosis (McDonagh et al., 2021).
Finally, we would like to draw attention to obesity that is important in the development of AF and stroke and systemic embolism, as the mean weight was almost close to overweight range in the study. We also have seen that age is actually an important predictor in terms of shedding light on future studies on the prediction of outcomes.
The article was prepared with the contributions of all authors.
期刊介绍：
The ANNALS OF NONINVASIVE ELECTROCARDIOLOGY (A.N.E) is an online only journal that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients.
ANE is the first journal in an evolving subspecialty that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients. The publication includes topics related to 12-lead, exercise and high-resolution electrocardiography, arrhythmias, ischemia, repolarization phenomena, heart rate variability, circadian rhythms, bioengineering technology, signal-averaged ECGs, T-wave alternans and automatic external defibrillation.
ANE publishes peer-reviewed articles of interest to clinicians and researchers in the field of noninvasive electrocardiology. Original research, clinical studies, state-of-the-art reviews, case reports, technical notes, and letters to the editors will be published to meet future demands in this field.
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