Atrial fibrillation in cryptogenic stroke and TIA patients in The Nordic Atrial Fibrillation and Stroke (NOR-FIB) Study: Main results

Ratajczak-Tretel, Barbara; Lambert, Anna Tancin; Al-Ani, R; Arntzen, Kathrine; Bakkejord, GK; Bekkeseth, H. M.O.; Bjerkeli, Vigdis; Eldøen, Guttorm; Gulsvik, A; Halvorsen, Bente; Hoie, GA; Ihle‐Hansen, Håkon; Ingebrigtsen, Susanne; Johansen, Henriette; Kremer, Christine; Krogseth, SB; Kruuse, Christina; Kurz, Martin; Nakstad, Ingvild; Novotný, Vojtěch; Næss, Halvor; Qazi, Rehman; Rezaj, MK; Rørholt, DM; Steffensen, Linn Hofsøy; Sømark, Jesper; Tobro, Håkon; Truelsen, TC; Wassvik, L.; Ægidius, K.; Atar, Dan; Aamodt, AH

doi:10.1177/23969873221123122

Cited by 8 publications

(11 citation statements)

References 29 publications

(57 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The minimal length necessary for AF diagnosis was 2 min based on the detection algorithm of the device. Intended time for continuous ECG observation was 1 year, 365 ± 20 days [2,21].…”

Section: Cardiac Rhythm Evaluationmentioning

confidence: 99%

“…AF or atrial flutter was detected in 28.6% of patients. Baseline patient characteristics are shown in Table 1 and were presented in an earlier paper focusing on the main results of the study [2].…”

Section: Re Sultsmentioning

confidence: 99%

“…

Undiagnosed atrial fibrillation (AF) is reported to be the underlying aetiology in one out of three cryptogenic stroke (CS) cases [1,2].Insertable cardiac monitors (ICMs) have been shown to identify a significantly higher rate of AF compared to other cardiac monitoring methods in patients with CS [3][4][5]. The detection rate of AF is reported to be up to 59% in CS patients with very early monitoring with ICMs starting within 3-5 days after admission [6].

…”

mentioning

confidence: 99%

“…Undiagnosed atrial fibrillation (AF) is reported to be the underlying aetiology in one out of three cryptogenic stroke (CS) cases [1,2].…”

mentioning

confidence: 99%

“…September 2020 in 18 participating centres in Norway, Denmark and Sweden [2]. The design of this study has been previously described [21].…”

mentioning

confidence: 99%

See 4 more Smart Citations

Biomarkers predictive of atrial fibrillation in patients with cryptogenic stroke. Insights from the Nordic Atrial Fibrillation and Stroke (NOR‐FIB) study

Lambert

Ratajczak-Tretel

Al-Ani

et al. 2023

Euro J of Neurology

Self Cite

View full text Add to dashboard Cite

Background and purpose There are currently no biomarkers to select cryptogenic stroke (CS) patients for monitoring with insertable cardiac monitors (ICMs), the most effective tool for diagnosing atrial fibrillation (AF) in CS. The purpose of this study was to assess clinically available biomarkers as predictors of AF. Methods Eligible CS and cryptogenic transient ischaemic attack patients underwent 12‐month monitoring with ICMs, clinical follow‐up and biomarker sampling. Levels of cardiac and thromboembolic biomarkers, taken within 14 days from symptom onset, were compared between patients diagnosed with AF (n = 74) during monitoring and those without AF (n = 185). Receiver operating characteristic curves were created. Biomarkers reaching area under the receiver operating characteristic curve ≥ 0.7 were dichotomized by finding optimal cut‐off values and were used in logistic regression establishing their predictive value for increased risk of AF in unadjusted and adjusted models. Results B‐type natriuretic peptide (BNP), N‐terminal pro‐brain natriuretic peptide (NT‐proBNP), creatine kinase, D‐dimer and high‐sensitivity cardiac troponin I and T were significantly higher in the AF than non‐AF group. BNP and NT‐proBNP reached the predefined area under the curve level, 0.755 and 0.725 respectively. Optimal cut‐off values were 33.5 ng/l for BNP and 87 ng/l for NT‐proBNP. Regression analysis showed that NT‐proBNP was a predictor of AF in both unadjusted (odds ratio 7.72, 95% confidence interval 3.16–18.87) and age‐ and sex‐adjusted models (odds ratio 4.82, 95% confidence interval 1.79–12.96). Conclusion Several clinically established biomarkers were associated with AF. NT‐proBNP performed best as AF predictor and could be used for selecting patients for long‐term monitoring with ICMs.

show abstract

“…The minimal length necessary for AF diagnosis was 2 min based on the detection algorithm of the device. Intended time for continuous ECG observation was 1 year, 365 ± 20 days [2,21].…”

Section: Cardiac Rhythm Evaluationmentioning

confidence: 99%

Section: Re Sultsmentioning

confidence: 99%

“…

…”

mentioning

confidence: 99%

“…Undiagnosed atrial fibrillation (AF) is reported to be the underlying aetiology in one out of three cryptogenic stroke (CS) cases [1,2].…”

mentioning

confidence: 99%

“…September 2020 in 18 participating centres in Norway, Denmark and Sweden [2]. The design of this study has been previously described [21].…”

mentioning

confidence: 99%

See 3 more Smart Citations

Biomarkers predictive of atrial fibrillation in patients with cryptogenic stroke. Insights from the Nordic Atrial Fibrillation and Stroke (NOR‐FIB) study

Lambert

Ratajczak-Tretel

Al-Ani

et al. 2023

Euro J of Neurology

Self Cite

View full text Add to dashboard Cite

show abstract

Prediction of underlying atrial fibrillation in patients with a cryptogenic stroke: results from the NOR-FIB Study

Ratajczak-Tretel¹,

Lambert²,

Al-Ani³

et al. 2023

J Neurol

View full text Add to dashboard Cite

Background Atrial fibrillation (AF) detection and treatment are key elements to reduce recurrence risk in cryptogenic stroke (CS) with underlying arrhythmia. The purpose of the present study was to assess the predictors of AF in CS and the utility of existing AF-predicting scores in The Nordic Atrial Fibrillation and Stroke (NOR-FIB) Study. Method The NOR-FIB study was an international prospective observational multicenter study designed to detect and quantify AF in CS and cryptogenic transient ischaemic attack (TIA) patients monitored by the insertable cardiac monitor (ICM), and to identify AF-predicting biomarkers. The utility of the following AF-predicting scores was tested: AS5F, Brown ESUS-AF, CHA2DS2-VASc, CHASE-LESS, HATCH, HAVOC, STAF and SURF. Results In univariate analyses increasing age, hypertension, left ventricle hypertrophy, dyslipidaemia, antiarrhythmic drugs usage, valvular heart disease, and neuroimaging findings of stroke due to intracranial vessel occlusions and previous ischemic lesions were associated with a higher likelihood of detected AF. In multivariate analysis, age was the only independent predictor of AF. All the AF-predicting scores showed significantly higher score levels for AF than non-AF patients. The STAF and the SURF scores provided the highest sensitivity and negative predictive values, while the AS5F and SURF reached an area under the receiver operating curve (AUC) > 0.7. Conclusion Clinical risk scores may guide a personalized evaluation approach in CS patients. Increasing awareness of the usage of available AF-predicting scores may optimize the arrhythmia detection pathway in stroke units.

show abstract

Imaging features for the identification of atrial fibrillation in cryptogenic stroke patients

Lambert,

Sætre,

Ratajczak-Tretel

et al. 2024

J Neurol

View full text Add to dashboard Cite

Background Whether specific imaging aspects can be used to identify cryptogenic stroke (CS) patients with high risk of underlying atrial fibrillation (AF) remains unclear. The purpose of this study was to evaluate brain-imaging features in CS patients and their utility as AF predictors. Methods The Nordic Atrial Fibrillation and Stroke study was a prospective observational study of CS and transient ischemic attack patients undergoing 12-month cardiac-rhythm monitoring, biomarker and clinical assessments. In this imaging sub-study, brain magnetic resonance imaging and computed tomography scans from 106 patients were assessed for acute and chronic ischemic lesions in relation to AF occurrence and included in a score to predict AF. Receiver operating characteristics (ROC) curve was used to evaluate the discriminative ability of the score and for its dichotomization for predictive model. Results Age, periventricular white-matter hyperintensities (PVWMH), acute lesion size, and vessel occlusion were significantly associated with AF. Acute and chronic cortical infarcts as well as chronic cerebellar infarcts were numerically more frequent in the AF group than the non-AF group. A score consisting of six features (0–6 points) was proposed (age ≥ 65 years, chronic cortical or cerebellar lesions, acute cortical lesions, PVWMH ≥ 2 in Fazekas scale, vessel occlusion, and acute lesion size ≥ 10 mm). Area under ROC curve was 0.735 and a score of ≥ 3 points was a predictor of AF. Conclusions The suggested score was shown to identify CS patients with an increased risk of underlying AF.

show abstract

Atrial fibrillation in cryptogenic stroke and TIA patients in The Nordic Atrial Fibrillation and Stroke (NOR-FIB) Study: Main results

Cited by 8 publications

References 29 publications

Biomarkers predictive of atrial fibrillation in patients with cryptogenic stroke. Insights from the Nordic Atrial Fibrillation and Stroke (NOR‐FIB) study

Biomarkers predictive of atrial fibrillation in patients with cryptogenic stroke. Insights from the Nordic Atrial Fibrillation and Stroke (NOR‐FIB) study

Prediction of underlying atrial fibrillation in patients with a cryptogenic stroke: results from the NOR-FIB Study

Imaging features for the identification of atrial fibrillation in cryptogenic stroke patients

Contact Info

Product

Resources

About