A simple score for predicting paroxysmal atrial fibrillation in acute ischemic stroke

Fujii, Shuichi; Shibazaki, Kensaku; Kimura, Kazumi; Sakai, Kenichiro; Aoki, Junya

doi:10.1016/j.jns.2013.02.025

Cited by 38 publications

(41 citation statements)

References 21 publications

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“…Additional predictors of paroxysmal AF in patients with cryptogenic stroke may include the NIH Stroke Scale score, 25 radiologic evidence of new cortical or cerebellar infarcts, 26 and cardiac biomarkers such as B-type natriuretic peptide, 27,28 highly sensitive cardiac troponin T, 29 and others. 30 However, in the CRYSTAL AF trial, we did not observe any correlation between infarction pattern and AF detection 31 and biomarker data were not collected.…”

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confidence: 99%

Predictors for atrial fibrillation detection after cryptogenic stroke

et al. 2016

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Objective: We assessed predictors of atrial fibrillation (AF) in cryptogenic stroke (CS) or transient ischemic attack (TIA) patients who received an insertable cardiac monitor (ICM). Methods:We studied patients with CS/TIA who were randomized to ICM within the CRYSTAL AF study. We assessed whether age, sex, race, body mass index, type and severity of index ischemic event, CHADS 2 score, PR interval, and presence of diabetes, hypertension, congestive heart failure, or patent foramen ovale and premature atrial contractions predicted AF development within the initial 12 and 36 months of follow-up using Cox proportional hazards models.Results: Among 221 patients randomized to ICM (age 61.6 6 11.4 years, 64% male), AF episodes were detected in 29 patients within 12 months and 42 patients at 36 months. Significant univariate predictors of AF at 12 months included age (hazard ratio [ Conclusion:Increasing age and a prolonged PR interval at enrollment were independently associated with an increased AF incidence in CS patients. However, they offered only moderate predictive ability in determining which CS patients had AF detected by the ICM. The CRYSTAL AF trial showed that the rate of atrial fibrillation (AF) detection among patients with cryptogenic stroke (CS) or transient ischemic attack (TIA) was 30% within 3 years after insertion of an insertable cardiac monitor (ICM). 1Numerous genetic, clinical, electrocardiographic, and echocardiographic features have been proposed as risk markers for developing AF.2-12 Within the Framingham Heart Study, a risk score for development of AF within 10 years was created, which included age, sex, body mass index, systolic blood pressure, treatment for hypertension, PR interval, clinically significant cardiac murmur, and heart failure.13 Echocardiographic measures did not improve risk prediction substantially.AF episodes are frequently asymptomatic and intermittent. Most CS/TIA patients monitored by ICM for AF detection have already undergone short-term Holter monitoring or telemetry in addition to cardiac and vascular imaging before device insertion.

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confidence: 99%

Predictors for atrial fibrillation detection after cryptogenic stroke

et al. 2016

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“…Необходимо при-нять во внимание, что кардиоэмболические инсульты составляют порядка 30% среди всех инсультов, вклю-чая криптогенные, ФП, в свою очередь, занимает среди причин кардиоэмболического инсульта 50%, а ИМ -10% [34]. Был предложен ряд шкал для опре-деления вероятности того, что перенесенный ишеми-ческий инсульт мог иметь кардиоэмболический генез (ФП) [35][36][37]. Общий критерий, встречающийся во всех трех шкалах, -диаметр левого предсердия, про-стой и достоверный параметр, отражающий наличие «субстрата» для ФП.…”

Section: New-onset Atrial Fibrillation In Acs впервые возникшая фибриunclassified

New-Onset Atrial Fibrillation in Settings of Acute Coronary Syndrome. Current Issues

Galjautdinov

Gorelkin

Ibragimova

et al. 2018

Racionalʹnaâ farmakoterapiâ v kardiologii

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451Настоящий обзор посвящен теме впервые возникшей фибрилляции предсердий (ФП) в условиях острого коронарного синдрома (ОКС). Использованы источники литературы баз PubMed, Scopus. ФП часто встречается в общей популяции и в популяции ОКС, при этом выделяют впервые возникшую ФП, и ФП, бывшую на момент развития ОКС. У пожилых пациентов с хронической сердечной недостаточностью, явле-ниями гемодинамической нестабильности и дилатацией левого предсердия возникновение ее более вероятно. Хорошо известно о предик-торах неблагоприятного исхода ОКС. Согласно некоторым данным, впервые возникшая ФП приводит к ухудшению прогноза, по другим данным причина ее сочетания с высоким уровнем летальности обусловлена тяжестью протекания ОКС, и возникновение ее не является не-зависимым предиктором смерти. Отсутствие субъективных симптомов во время пароксизма ФП не позволяет оценить его продолжительность, и тем самым дифференцировать впервые возникший пароксизм и постоянную или персистирующую форму ФП. Удается проследить связь между ишемией миокарда и возникновением ФП. Неэффективная реперфузия во время проведения чрескожного коронарного вмеша-тельства или тромболитической терапии сопровождается возникновением фибрилляции предсердий, напротив, при достижении эффек-тивной проходимости сосуда она возникает реже. Впервые возникшая при ОКС, и, в частности, сопровождающаяся кардиогенным шоком, ФП требует экстренной кардиоверсии: медикаментозной или электроимпульсной. В ряде случаев проведение активной кардиоверсии не требуется, поскольку восстановление синусового ритма происходит спонтанно. Неоднозначность и многофакторность данной проблемы указывает на необходимость более детального понимания механизмов аритмогенеза и разработки инструментов для стратификации рисков возникновения ФП при ОКС.Ключевые слова: фибрилляция предсердий, острый коронарный синдром, левое предсердие, асимптомная фибрилляция предсердий, чрескожное коронарное вмешательство, кардиоэмболический инсульт. The present review is focuses on new onset atrial fibrillation (AF) in conditions of acute coronary syndrome (ACS). Literature sources from PubMed and Scopus was used. AF is common in the general population and in the ACS population, at that new onset AF, and AF, which was by the time of ACS development are determined. Appearance of AF is more likely amongst the elderly patients with congestive heart failure, with signs of the hemodynamic instability and with the left atrium dilatation. It is well-known about the predictors of adverse outcome in ACS. According to some literature data new onset AF leads to worsening of prognosis, and in line with other sources a reason of its association with high level of mortality is due to the severity of ACS and appearance of AF is not independent predictor of death. The absence of subjective symptoms at the time of paroxysm of new onset AF does not allow estimating its duration and distinguishing between the new onset AF, persistent and constant AF. It is possible to trace the relationship between the myocardial ischemia and AF appeara...

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“…LADS ≥ had good sensitivity (85 %) but poor specificity (53 %) for the detection of AF after stroke or TIA [50]. A third scale, by Fujii et al, consisted of NIHSS score ≥8 (1 point), left atrial dilatation (1 point), mitral valve disease (1 point), and BNP ≥144 pg/dl (2 points) [51]. A score of ≥3 on this scale had a sensitivity and specificity of 78 and 83 %, respectively, for the detection of PAF [51].…”

Section: Predictors Of Afmentioning

confidence: 99%

“…Left atrial enlargement (LAE) is also predictive of AF in stroke [36,48,50,51,72]. LAE is also an independent risk factor for recurrent cardioembolic stroke [73] Electrocardiogram predictors PR interval prolongation is a predictor of incident AF [74].…”

Section: Echocardiogram Predictorsmentioning

confidence: 99%

Paroxysmal Atrial Fibrillation: Novel Strategies for Monitoring and Implications for Treatment in Stroke

Silverman

2016

Curr Treat Options Cardio Med

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In cryptogenic stroke, prolonged cardiac monitoring is often employed to search for and diagnose atrial fibrillation (AF). Multiple monitoring modalities with multiple durations of monitoring exist. Finding atrial fibrillation after an ischemic stroke is extremely important as anticoagulation is the standard of care and results in the lowest stroke recurrence rate. The protocol at our institution is to carry out 30-day mobile cardiac outpatient telemetry (MCOT) in all patients with cryptogenic stroke. If this MCOT fails to reveal AF, yet the suspicion is high based on the presence of clinical, biochemical, electrocardiographic, and echocardiographic factors, we may proceed to use an implantable cardiac monitor. When AF is diagnosed after cryptogenic stroke, regardless of its duration and assuming no contraindications exist, anticoagulation is recommended with either warfarin or one of the DOACs (direct oral anticoagulants).

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A simple score for predicting paroxysmal atrial fibrillation in acute ischemic stroke

Cited by 38 publications

References 21 publications

Predictors for atrial fibrillation detection after cryptogenic stroke

Predictors for atrial fibrillation detection after cryptogenic stroke

New-Onset Atrial Fibrillation in Settings of Acute Coronary Syndrome. Current Issues

Paroxysmal Atrial Fibrillation: Novel Strategies for Monitoring and Implications for Treatment in Stroke

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