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Open Access Highly Accessed Research article

The determinants of stroke phenotypes were different from the predictors (CHADS2 and CHA2DS2-VASc) of stroke in patients with atrial fibrillation: a comprehensive approach

Semi Oh, Suk Jae Kim, Soo-Kyoung Ryu, Gyeong-Moon Kim, Chin Sang Chung, Kwang Ho Lee and Oh Young Bang*

Author affiliations

Department of Neurology, Stroke and Cerebrovascular Centre, Samsung Medical Centre, Sungkyunkwan University, South Korea

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Citation and License

BMC Neurology 2011, 11:107  doi:10.1186/1471-2377-11-107

Published: 24 August 2011

Abstract

Background

Atrial fibrillation (AF) is a leading cause of fatal ischemic stroke. It was recently reported that international normalized ratio (INR) levels were associated with infarct volumes. However, factors other than INR levels that affect stroke phenotypes are largely unknown. Therefore, we evaluated the determinants of stroke phenotypes (pattern and volume) among patients with AF who were not adequately anticoagulated.

Methods

We analyzed data pertaining to consecutive AF patients admitted over a 6-year period with acute MCA territory infarcts. We divided the patients according to DWI (diffusion-weighted imaging) lesion volumes and patterns, and the relationship between stroke predictors (the CHADS2 and CHA2DS2-VASc score), systemic, and local factors and each stroke phenotype were then evaluated.

Results

The stroke phenotypes varied among 231 patients (admission INR median 1.06, interquartile range (IQR) 1.00-1.14). Specifically, (1) the DWI lesion volumes ranged from 0.04-338.62 ml (median 11.86 ml; IQR, 3.07-44.20 ml) and (2) 46 patients had a territorial infarct pattern, 118 had a lobar/deep pattern and 67 had a small scattered pattern. Multivariate testing revealed that the CHADS2 and CHA2DS2-VASc score were not related to either stroke phenotype. Additionally, the prior use of antiplatelet agents was not related to the stroke phenotypes. Congestive heart failure and diastolic dysfunction were not associated with stroke phenotypes.

Conclusions

The results of this study indicated that the determinants of stroke phenotypes were different from the predictors (i.e., CHADS2 and CHA2DS2-VASc score) of stroke in patients with AF.