{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T07:33:11Z","timestamp":1767598391459,"version":"3.41.2"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,5,13]],"date-time":"2022-05-13T00:00:00Z","timestamp":1652400000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p>Anticoagulants reduce embolic risk in atrial fibrillation (AF), despite increasing hemorrhagic risk. In this context, validity of congestive heart failure, hypertension, age \u2265 75 years, diabetes, stroke, vascular disease, age 65\u201374 years and sex category (CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VASc) and hypertension, abnormal renal\/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs\/alcohol concomitantly (HAS\u2013BLED) scales, used to respectively evaluate thrombotic and hemorrhagic risks, is incomplete. In patients with AF, brain MRI has led to the increased detection of \u201casymptomatic\u201d brain changes, particularly those related to small vessel disease, which also represent the pathologic substrate of intracranial hemorrhage, and silent brain infarcts, which are considered risk factors for ischemic stroke. Routine brain MRI in asymptomatic patients with AF is not yet recommended. Our aim was to test predictive ability of risk stratification scales on the presence of cerebral microbleeds, lacunar, and non-lacunar infarcts in 170 elderly patients with AF on oral anticoagulants. <jats:italic>Ad hoc<\/jats:italic> developed R algorithms were used to evaluate CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VASc and HAS\u2013BLED sensitivity and specificity on the prediction of cerebrovascular lesions: (1) Maintaining original items' weights; (2) augmenting weights' range; (3) adding cognitive, motor, and depressive scores. Accuracy was poor for each outcome considering both scales either in phase 1 or phase 2. Accuracy was never improved by the addition of cognitive scores. The addition of motor and depressive scores to CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VASc improved accuracy for non-lacunar infarcts (sensitivity = 0.70, specificity = 0.85), and sensitivity for lacunar\u2013infarcts (sensitivity = 0.74, specificity = 0.61). Our results are a very first step toward the attempt to identify those elderly patients with AF who would benefit most from brain MRI in risk stratification.<\/jats:p>","DOI":"10.3389\/fneur.2022.883786","type":"journal-article","created":{"date-parts":[[2022,5,13]],"date-time":"2022-05-13T04:59:33Z","timestamp":1652417973000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Can CHA2DS2-VASc and HAS\u2013BLED Foresee the Presence of Cerebral Microbleeds, Lacunar and Non-Lacunar Infarcts in Elderly Patients With Atrial Fibrillation? Data From Strat\u2013AF Study"],"prefix":"10.3389","volume":"13","author":[{"given":"Elisa","family":"Bianconi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Del Freo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emilia","family":"Salvadori","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmen","family":"Barbato","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benedetta","family":"Formelli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Pescini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Pracucci","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Sarti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Cesari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Chiti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Diciotti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna Maria","family":"Gori","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiara","family":"Marzi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enrico","family":"Fainardi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Betti","family":"Giusti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rossella","family":"Marcucci","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruno","family":"Bertaccini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Poggesi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,5,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2071","DOI":"10.1161\/CIR.0000000000000040","article-title":"2014 AHA\/ACC\/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology\/American Heart Association task force on practice guidelines and the heart rhythm society","volume":"130","author":"January","year":"2014","journal-title":"J Am Coll Cardiol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"e125","DOI":"10.1161\/CIR.0000000000000665","article-title":"2019 AHA\/ACC\/HRS Focused Update of the 2014 AHA\/ACC\/HRS Guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines and the heart rhythm society in collaboration with the society of thoracic surgeons","volume":"140","author":"January","year":"2019","journal-title":"Circulation."},{"key":"B3","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1378\/chest.09-1584","article-title":"Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation","volume":"137","author":"Lip","year":"2010","journal-title":"Chest."},{"key":"B4","doi-asserted-by":"publisher","first-page":"2719","DOI":"10.1093\/eurheartj\/ehs253","article-title":"2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association","volume":"33","author":"Camm","year":"2012","journal-title":"Eur Heart J"},{"key":"B5","doi-asserted-by":"publisher","first-page":"2893","DOI":"10.1093\/eurheartj\/ehw210","article-title":"2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS","volume":"37","author":"Kirchhof","year":"2016","journal-title":"Eur Heart J."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1093","DOI":"10.1378\/chest.10-0134","article-title":"novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey","volume":"138","author":"Pisters","year":"2010","journal-title":"Chest."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1950","DOI":"10.1001\/jama.2015.4369","article-title":"Stroke prevention in atrial fibrillation: a systematic review","volume":"313","author":"Lip","year":"2015","journal-title":"JAMA."},{"key":"B8","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1016\/S1474-4422(10)70104-6","article-title":"Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges","volume":"9","author":"Pantoni","year":"2010","journal-title":"Lancet Neurol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"719","DOI":"10.1161\/STROKEAHA.115.011889","article-title":"Silent brain infarction and risk of future stroke: a systematic review and meta-analysis","volume":"47","author":"Gupta","year":"2016","journal-title":"Stroke."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1408","DOI":"10.1136\/heartjnl-2013-305151","article-title":"Brain MRI to personalise atrial fibrillation therapy: current evidence and perspectives","volume":"100","author":"Haeusler","year":"2014","journal-title":"Heart."},{"key":"B11","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1016\/S1474-4422(18)30145-5","article-title":"Cerebral microbleeds and intracranial haemorrhage risk in patients anticoagulated for atrial fibrillation after acute ischaemic stroke or transient ischaemic attack (CROMIS-2): a multicentre observational cohort study","volume":"17","author":"Wilson","year":"2018","journal-title":"Lancet Neurol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e2432","DOI":"10.1212\/WNL.0000000000007532","article-title":"MRI predicts intracranial hemorrhage in patients who receive long-term oral anticoagulation","volume":"92","author":"Mart\u00ed-F\u00e0bregas","year":"2019","journal-title":"Neurology."},{"key":"B13","doi-asserted-by":"publisher","first-page":"904","DOI":"10.1161\/STROKEAHA.115.011150","article-title":"Embolic stroke, atrial fibrillation, and microbleeds: is there a role for anticoagulation?","volume":"47","author":"Diener","year":"2016","journal-title":"Stroke."},{"key":"B14","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1007\/s12975-018-0678-z","article-title":"Management of cerebral microbleeds in clinical practice","volume":"10","author":"Shuaib","year":"2019","journal-title":"Transl Stroke Res."},{"key":"B15","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1007\/978-3-319-77932-4_36","article-title":"Precision medicine and personalized medicine in cardiovascular disease","volume":"1065","author":"Currie","year":"2018","journal-title":"Adv Exp Med Biol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"626","DOI":"10.3390\/medicina55100626","article-title":"Role of biological markers for cerebral bleeding risk STRATification in patients with atrial fibrillation on oral anticoagulants for primary or secondary prevention of ischemic stroke (Strat-AF Study): study design and methodology","volume":"55","author":"Poggesi","year":"2019","journal-title":"Medicina."},{"key":"B17","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1111\/j.1532-5415.2005.53221.x","article-title":"The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment","volume":"53","author":"Nasreddine","year":"2005","journal-title":"J Am Geriatr Soc"},{"key":"B18","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1007\/s10072-014-1921-3","article-title":"Montreal cognitive assessment (MoCA)-Italian version: regression based norms and equivalent scores","volume":"36","author":"Conti","year":"2015","journal-title":"Neurol Sci."},{"key":"B19","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1080\/01688639708403761","article-title":"Composite neuropsychological batteries and demographic correction: standardization based on equivalent scores, with a review of published data. The italian group for the neuropsychological study of ageing","volume":"19","author":"Capitani","year":"1997","journal-title":"J Clin Exp Neuropsychol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"M85","DOI":"10.1093\/geronj\/49.2.M85","article-title":"A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission","volume":"49","author":"Guralnik","year":"1994","journal-title":"J Gerontol."},{"key":"B21","first-page":"709","article-title":"Geriatric depression scale","volume":"24","author":"Yesavage","year":"1988","journal-title":"Psychopharmacol Bull."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1759","DOI":"10.1212\/WNL.0b013e3181c34a7d","article-title":"The microbleed anatomical rating scale (MARS): reliability of a tool to map brain microbleeds","volume":"73","author":"Gregoire","year":"2009","journal-title":"Neurology."},{"key":"B23","doi-asserted-by":"publisher","first-page":"822","DOI":"10.1016\/S1474-4422(13)70124-8","article-title":"Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration","volume":"12","author":"Wardlaw","year":"2013","journal-title":"Lancet Neurol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1186\/s12916-016-0763-7","article-title":"Short physical performance battery and all-cause mortality: systematic review and meta-analysis","volume":"14","author":"Pavasini","year":"2016","journal-title":"BMC Med."},{"key":"B25","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1093\/ageing\/afr169","article-title":"Depression in older people in the general hospital: a systematic review of screening instruments","volume":"41","author":"Dennis","year":"2012","journal-title":"Age Ageing."},{"key":"B26","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1002\/1097-0142(1950)3:1<32::AID-CNCR2820030106>3.0.CO;2-3","article-title":"Index for rating diagnostic tests","volume":"3","author":"Youden","year":"1950","journal-title":"Cancer."},{"key":"B27","doi-asserted-by":"publisher","first-page":"e010582","DOI":"10.1161\/JAHA.118.010582","article-title":"Bleeding risk scores in atrial fibrillation: helpful or harmful?","volume":"7","author":"Edmiston","year":"2018","journal-title":"J Am Heart Assoc."}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2022.883786\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,13]],"date-time":"2022-05-13T04:59:38Z","timestamp":1652417978000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2022.883786\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,13]]},"references-count":27,"alternative-id":["10.3389\/fneur.2022.883786"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2022.883786","relation":{},"ISSN":["1664-2295"],"issn-type":[{"type":"electronic","value":"1664-2295"}],"subject":[],"published":{"date-parts":[[2022,5,13]]},"article-number":"883786"}}