CHADS-VASc Scores are Proportionally Associated with Left Atrial Enlargement and Serum D-dimer Levels in Patients with Non-valvular Atrial Fibrillation

Background Virchow’s triad, consisting of atrial tissue damage, a hypercoagulable state, and blood stasis, has been used to explain the thrombogenic mechanisms of non-valvular atrial fibrillation (NVAF). Blood stasis is thought to be attributable to loss of left atrial systole and left atrial enlargement, while the hypercoagulable state is partly reflected by elevated serum D-dimer levels. The aim of this study was to evaluate the correlation between risk factors for CHA2DS2-VASc and left atrial enlargement/serum D-dimer levels in order to explore whether LAE with D-dimer elevation is one of the key factors in the thrombogenic mechanisms of atrial fibrillation. Methods Consecutive patients with acute ischemic stroke due to NVAF who were anticoagulation-naïve were enrolled. All patients were evaluated for left atrial volume index (LAVI) by transthoracic echocardiography. The association between CHA2DS2-VASc scores and LAVI/D-dimer levels was evaluated. Results A total of 98 anticoagulation-naïve patients who presented with acute ischemic stroke due to NVAF were enrolled in this study. CHA2DS2-VASc scores were significantly correlated with left atrial volume index (r=0.325, P=0.002). There was also a significant correlation between CHA2DS2-VASc scores and serum D-dimer levels (r=0.309, P=0.006). Conclusions CHA2DS2-VASc scores were associated with left atrial enlargement (LAE) and increased D-dimer levels in anticoagulation-naïve patients with acute ischemic stroke due to NVAF. LAE may play a crucial role in the link between CHA2DS2-VASc risk factors and the development of ischemic stroke, and these hypercoagulable conditions seem to be reflected by an elevation in D-dimer levels.