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• W2023802987 abstract "A cardioembolia representa uma das causas mais frequentes de lesões cerebrovasculares isquémicas, com prevalência estimada de 20-30% e implicações terapêuticas diretas que obrigam à sua correta avaliação. Apesar de a validação das escalas de risco cardioembólico (CHADS2 e, mais recentemente, CHA2DS2-VASc) em populações heterogéneas de doentes com fibrilhação furicular, desconhece-se ainda a sua validade em contexto de prevenção secundária cerebrovascular. É objetivo deste trabalho estudar a sensibilidade e especificidade diferencial das escalas de risco cardioembólico como preditoras de fonte cardioembólica documentada por ecocardiograma transesofágico (ETE) numa população de doentes com AVC isquémico. Aplicámos as escalas CHADS2 e CHA2DS2-VASc a todos os doentes internados por evento cerebrovascular isquémico na Unidade de AVC/Enfermaria de Neurologia de um hospital central português com diagnóstico de fibrilhação auricular (prévio ou obtido durante/após o internamento), que realizaram ETE entre janeiro e agosto de 2011. Definimos como presença de fonte cardioembólica a observação em ETE de autocontraste espontâneo na aurícula e apêndice auricular esquerdo ou trombos nas cavidades cardíacas esquerdas. Analisámos 94 doentes, 66,0% do sexo masculino, idade média: 64,4 anos (desvio padrão: 14,2). Foi detetada fonte cardioembólica em 20 doentes. A análise de curva Receiver Operating Characteristic (ROC) identifica como preditores de fonte cardioembólica pontuação CHADS2 ≥ 4; sensibilidade: 75,0%, especificidade: 66,0%, p = 0,014 e pontuação CHA2DS2-VASc ≥ 5; sensibilidade: 83,3%, especificidade: 58,0%, p = 0,009. Ambas as escalas apresentam sensibilidade significativa como preditoras de risco cardioembólico em contexto de prevenção secundária cerebrovascular. A escala CHA2DS2-VASc possui uma sensibilidade superior à CHADS2, sendo, no entanto, menos específica. Cardioembolism is one of the most common causes of ischemic stroke, with an estimated prevalence of 20-30%, and correct diagnosis is essential given the therapeutic implications. Although stroke risk scores (CHADS2 and more recently CHA2DS2-VASc) have been validated in heterogeneous populations of patients with atrial fibrillation, their accuracy has not been ascertained for secondary stroke prevention. We set out to assess the sensitivity and specificity of the CHADS2 and CHA2DS2-VASc stroke risk scores as predictors of cardioembolic sources, documented by transesophageal echocardiography (TEE) in a population with ischemic stroke. The CHADS2 and CHA2DS2-VASc scores were applied to all patients admitted to the stroke unit/neurology ward of a Portuguese tertiary hospital with atrial fibrillation (diagnosed previously or during or after admission) who underwent TEE between January and August 2011. The presence of a cardioembolic source was defined as the observation by TEE of spontaneous echo contrast in the left atrium and atrial appendage or thrombi in the left cardiac chambers. We studied 94 patients, 66.0% male, mean age 64.4 years (standard deviation 14.2). A cardioembolic source was detected in 20 patients. ROC curve analysis identified as predictors of cardioembolic source CHADS2 score ≥4 (sensitivity of 75.0%, specificity of 66.0%, p=0.014) and CHA2DS2-VASc score ≥5 (sensitivity of 83.3%, specificity of 58.0%, p=0.009). Both scores showed acceptable sensitivity as predictors of embolic risk in the context of secondary prevention of cardioembolic stroke. The CHA2DS2-VASc score has higher sensitivity than CHADS2 but lower specificity." @default.
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• W2023802987 date "2013-05-01" @default.
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• W2023802987 title "CHADS2 e CHA2DS2VASc como preditores de fonte cardioembólica em prevenção secundária cerebrovascular" @default.
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