Abstract 16198: Cystatin C-based Estimated Glomerular Filtration Rate (eGFR) is a Superior Predictor for Cardioembolic Stroke to Creatinine-based eGFR in Patients With Atrial Fibrillation
Introduction: Chronic kidney disease (CKD) is an important risk factor for cardioembolic stroke in patients with atrial fibrillation (AF). The estimated glomerular filtration rate (eGFR) is a popularized index for assessing kidney function and calculated using serum creatinine or cystatin C. Compared with creatinine-based eGFR (eGFRcr), cystatin C-based eGFR (eGFRcys) is less affected by age, gender and muscle mass. We investigated whether eGFRcys is associated with development of cardioembolic stroke in patients with AF.
Methods: We performed transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) and measured eGFRcys and eGFRcr in 480 patients with paroxysmal AF or chronic AF (337 males, 64 ± 12 years). We excluded the patients who did not undergo TEE and those who had severe valvular heart disease and severe renal dysfunction.
Results: There were 128 patients with new-onset cardioembolic stroke. eGFRcys showed better correlation with left atrial volume index and left atrial appendage emptying flow velocity than eGFRcr. eGFRcys was decreased with increasing CHADS2 and CHA2DS2VASc score. Patients with left atrial appendage thrombus and/or spontaneous echo contrast had a significantly lower eGFRcys compared to those without. Further, the proportion of patients with cardioembolic stroke was increased with advancing CKD stage based on eGFRcys (Figure). In ROC analysis, area under the curve was larger for eGFRcys than eGFRcr (0.804 vs. 0.643, P < 0.05). Although logistic regression analysis showed that both eGFRcys and eGFRcr were associated with cardioembolic stroke, eGFRcys but not eGFRcr was an independent predictor for cardioembolic stroke after adjustment for CHADS2 score.
Conclusion: eGFRcys is a superior predictor for cardioembolic stroke to eGFRcr in patients with AF.
Author Disclosures: N. Hashimoto: None. S. Nishiyama: None. T. Watanabe: None. M. Wanezaki: None. G. Yamaura: None. H. Tamura: None. T. Arimoto: None. H. Takahashi: None. T. Shishido: None. T. Miyamoto: None. I. Kubota: None.
- © 2016 by American Heart Association, Inc.