Atrial fibrillation in cryptogenic stroke and transient ischaemic attack – The Nordic Atrial Fibrillation and Stroke (NOR-FIB) Study: Rationale and design

Ratajczak-Tretel, Barbara; Lambert, Anna Tancin; Johansen, Henriette; Halvorsen, Bente; Bjerkeli, Vigdis; Russell, David; Sandset, Else Charlotte; Ihle‐Hansen, Hege; Eriksen, Erik Fink; Næss, Halvor; Novotný, Vojtěch; Khanevski, Andrej Netland; Truelsen, Thomas; Idicula, Titto; Ægidius, Karen; Tobro, Håkon; Krogseth, Siv Bohne; Ihle‐Hansen, Håkon; Hagberg, Guri; Kruuse, Christina; Arntzen, Kathrine; Villseth, Maja; Nakstad, Ingvild; Eldøen, Guttorm; Shafiq, Raheel; Gulsvik, A; Kurz, Martin; Rezai, M; Sømark, Jesper; Tingvoll, Stein-Helge; Jonassen, Christine Monceyron; Ingebrigtsen, Susanne; Steffensen, Linn Hofsøy; Kremer, Christine; Atar, Dan; Aamodt, Anne Hege

doi:10.1177/2396987319837089

Cited by 11 publications

(16 citation statements)

References 37 publications

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“…Cryptogenic stroke end TIA patients evaluated in The Nordic Atrial Fibrillation and Stroke (NORFIB) study 10 : MRI showing multi‐territory diffusion changes in patient with occult atrial fibrillation (A), Computed tomography angiogram (CTA) showing nonstenotic unstable plaque in the left internal carotid artery (B), Positron emission tomography (PET) showing occult malignancy in the right lung detected a few months after a cryptogenic stroke (C)…”

Section: Discussionmentioning

confidence: 99%

“…Identifying new biomarkers to help selecting patients with the highest possibility of detecting AF by prolonged monitoring may be a useful tool. 10 As the recent LOOP study failed to show a significant reduction in strokes in high-risk patients with AF detected by ICM, 11 careful evaluation of the significance of short and subclinical AF episodes is still crucial. The LOOP study findings might also imply that not only AF itself but the more complex atrial cardiopathy contributes to the risk of cardioembolic stroke.…”

Section: O Ccult Atrial Fib Rill Ati On-look Long Er and Us E More So...mentioning

confidence: 99%

“…This benefit must be balanced against larger costs due to the ICMs use, so more personalized strategies are needed. Identifying new biomarkers to help selecting patients with the highest possibility of detecting AF by prolonged monitoring may be a useful tool 10 . As the recent LOOP study failed to show a significant reduction in strokes in high‐risk patients with AF detected by ICM, 11 careful evaluation of the significance of short and subclinical AF episodes is still crucial.…”

Section: Occult Atrial Fibrillation—look Longer and Use More Sophisti...mentioning

confidence: 99%

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Cryptogenic stroke and TIA: Suggested diagnostic approach while waiting for evaluation and treatment guidelines

Ratajczak-Tretel

Lambert

Atar

et al. 2022

Acta Neuro Scandinavica

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The etiology of approximately one third of ischemic strokes remains undetermined, resulting in their classification as cryptogenic. 1 One sixth meet the definition of embolic stroke of undetermined source (ESUS). 2 The category cryptogenic is heterogeneous and includes cases with unknown etiology, where two or more competing causes are possible, or where the investigation is incomplete. ESUS occurs in the absence of lacunar infarcts, significant stenosis in pre-and cerebral arteries, or cardiac conditions with high risk of embolism, such as atrial fibrillation. Treatment is challenging: it is unknown whether standard secondary prevention provides sufficient protection against recurrence in all cases, while an empiric strategy of routinely administered anticoagulation appears to be both harmful

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Section: Discussionmentioning

confidence: 99%

Section: O Ccult Atrial Fib Rill Ati On-look Long Er and Us E More So...mentioning

confidence: 99%

Section: Occult Atrial Fibrillation—look Longer and Use More Sophisti...mentioning

confidence: 99%

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Cryptogenic stroke and TIA: Suggested diagnostic approach while waiting for evaluation and treatment guidelines

Ratajczak-Tretel

Lambert

Atar

et al. 2022

Acta Neuro Scandinavica

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“…24,26 Several randomised studies evaluating these markers of atrial cardiopathy are currently in progress. [52][53][54] Our findings were limited by small sample sizes and incomplete reporting. Patient selection and eligibility varied significantly.…”

Section: Discussionmentioning

confidence: 99%

Molecular biomarkers predicting newly detected atrial fibrillation after ischaemic stroke or TIA: A systematic review

Ward

Vail

Cameron

et al. 2022

European Stroke Journal

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Background: Several molecular biomarkers are available that predict newly detected atrial fibrillation (NDAF). We aimed to identify such biomarkers that predict NDAF after an Ischaemic stroke (IS)/Transient Ischaemic Attack (TIA) and evaluate their performance. Methods: A systematic review was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies of patients with IS, TIA, or both, who underwent ECG monitoring for ⩾24 h, which reported molecular biomarkers and frequency of NDAF after electronic searches of multiple databases were included. Results: Twenty-one studies (76% IS, 24% IS and TIA) involving 4640 patients were included. Twelve biomarkers were identified, with cardiac biomarkers evaluated in the majority (75%) of patients. Performance measures were inconsistently reported. Among cohorts selecting high-risk individuals (12 studies), the most studied biomarkers were N-Terminal-Pro Brain Natriuretic Peptide (NT-ProBNP, five studies; C-statistics reported by three studies, 0.69–0.88) and Brain Natriuretic Peptide (BNP, two studies; C-statistics reported in two studies, 0.68–0.77). Among unselected cohorts (nine studies), the most studied biomarker was BNP (six studies; C-statistics reported in five studies, 0.75–0.88). Only BNP was externally validated (two studies) but using different thresholds to categorise risk of NDAF. Conclusion: Cardiac biomarkers appear to have modest to good discrimination for predicting NDAF, although most analyses were limited by small, heterogeneous study populations. Their clinical utility should be explored further, and this review supports the need to assess the role of molecular biomarkers in large prospective studies with standardised selection criteria, definition of clinically significant NDAF and laboratory assays.

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“…Approximately one-third of ischemic strokes are related to the presence of unknown atrial fibrillation (AF). [5][6][7] In this case, strokes are more severe, more disabling, associated with cognitive decline, and with a higher risk of institutionalization than strokes from other causes. 8 Consequently, it is clear that the costs related to AF will increase, constituting a major public health problem.…”

Section: Introductionmentioning

confidence: 99%

<p>Risk of Atrial Fibrillation, Ischemic Stroke and Cognitive Impairment: Study of a Population Cohort ≥65 Years of Age</p>

Clúa-Espuny

Muria-Subirats

Ballesta-Ors

et al. 2020

VHRM

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Purpose To evaluate a model for calculating the risk of AF and its relationship with the incidence of ischemic stroke and prevalence of cognitive decline. Materials and Methods It was a multicenter, observational, retrospective, community-based study of a cohort of general population ≥6ct 35 years, between 01/01/2016 and 31/12/2018. Setting: Primary Care. Participants: 46,706 people ≥65 years with an active medical history in any of the primary care teams of the territory, information accessible through shared history and without previous known AF. Interventions: The model to stratify the risk of AF (PI) has been previously published and included the variables sex, age, mean heart rate, mean weight and CHA2DS2VASc score. Main measurements: For each risk group, the incidence density/1000 person/years of AF and stroke, number of cases required to detect a new AF, the prevalence of cognitive decline, Kendall correlation, and ROC curve were calculated. Results The prognostic index was obtained in 37,731 cases (80.8%) from lowest (Q1) to highest risk (Q4). A total of 1244 new AFs and 234 stroke episodes were diagnosed. Q3-4 included 53.8% of all AF and 69.5% of strokes in men; 84.2% of all AF and 85.4% of strokes in women; and 77.4% of cases of cognitive impairment. There was a significant linear correlation between the risk-AF score and the Rankin score (p < 0.001), the Pfeiffer score (p < 0.001), but not NIHSS score (p 0.150). The overall NNS was 1/19. Conclusion Risk stratification allows identifying high-risk individuals in whom to intervene on modifiable risk factors, prioritizing the diagnosis of AF and investigating cognitive status.

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Atrial fibrillation in cryptogenic stroke and transient ischaemic attack – The Nordic Atrial Fibrillation and Stroke (NOR-FIB) Study: Rationale and design

Cited by 11 publications

References 37 publications

Cryptogenic stroke and TIA: Suggested diagnostic approach while waiting for evaluation and treatment guidelines

Cryptogenic stroke and TIA: Suggested diagnostic approach while waiting for evaluation and treatment guidelines

Molecular biomarkers predicting newly detected atrial fibrillation after ischaemic stroke or TIA: A systematic review

<p>Risk of Atrial Fibrillation, Ischemic Stroke and Cognitive Impairment: Study of a Population Cohort ≥65 Years of Age</p>

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