ArticleCardiovascular therapeutics2026
Development and Validation of a Nomogram for Estimating Stroke Risk in Nonvalvular Atrial Fibrillation Patients With Left Atrial Stiffness: A Single-Center Cross-Sectional Study.
Article in Cardiovascular therapeutics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Abstract
backgroundNonvalvular atrial fibrillation (NVAF) is a prevalent arrhythmia associated with an increased risk of ischemic stroke. This study is aimed at assessing the clinical significance of echocardiographic left atrial (LA) stiffness and developing a nomogram integrating clinical and echocardiographic parameters to evaluate individualized stroke risk in NVAF patients.
methodsWe enrolled 402 consecutive NVAF patients between January 2020 and March 2023. Clinical and echocardiographic data were collected, and patients were randomly assigned to training (n = 281) and validation (n = 121) datasets. Univariate and multivariate logistic regression identified independent stroke risk factors, which were used to construct a nomogram. Model performance was evaluated by receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis. The reclassification ability of the nomogram was assessed using integrated discrimination improvement (IDI) and net reclassification improvement (NRI).
resultsLogistic regression identified LA stiffness, LA reservoir strain, hypertension, peripheral vascular disease, and anticoagulation as independent factors associated with stroke. The nomogram based on these factors showed excellent discrimination, with a C-statistic of 0.889 (0.847-0.924) in the training cohort and 0.880 (0.808-0.932) in the validation cohort. Model A (LA stiffness, LA reservoir strain, hypertension, peripheral vascular disease, and anticoagulation) provided better net reclassification and integrated discrimination than Model B (LA stiffness, LA reservoir strain, hypertension, and peripheral vascular disease) despite both outperforming the CHA
conclusionA nomogram incorporating LA stiffness, LASr, hypertension, and peripheral vascular disease can effectively identify the risk of stroke in NVAF patients. Additionally, a secondary model including anticoagulation showed further improved performance but requires prospective validation. Elevated LA stiffness might play a role in the development of stroke in NVAF by influencing LA appendage hemodynamics.
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