Detection of Atrial Fibrillation in Cryptogenic Stroke

Hæusler, Karl Georg; Tütüncü, Serdar; Schnabel, Renate B.

doi:10.1007/s11910-018-0871-1

Cited by 36 publications

(34 citation statements)

References 53 publications

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“…There is, however, no consensus regarding the optimal duration and timing of cardiac rhythm monitoring. Based on the detection rates of AF with insertable cardiac monitors from earlier studies [5], the identification of reliable biomarkers associated with AF would allow more targeted selection of patients for prolonged cardiac rhythm monitoring. To our knowledge, studies combining monitoring of CS and TIA patients with insertable cardiac monitors and the identification of AF-specific biomarkers from a broad spectrum of molecular biomarkers have not been performed.…”

Section: Introductionmentioning

confidence: 99%

Biomarkers Associated with Atrial Fibrillation in Patients with Ischemic Stroke: A Pilot Study from the NOR-FIB Study

Lambert¹,

Kong²,

Ratajczak-Tretel³

et al. 2020

Cerebrovasc Dis Extra

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Background and Purpose: Cardioembolic stroke due to paroxysmal atrial fibrillation (AF) may account for 1 out of 4 cryptogenic strokes (CS) and transient ischemic attacks (TIAs). The purpose of this pilot study was to search for biomarkers potentially predicting incident AF in patients with ischemic stroke or TIA. Methods: Plasma samples were collected from patients aged 18 years and older with ischemic stroke or TIA due to AF (n = 9) and large artery atherosclerosis (LAA) with ipsilateral carotid stenosis (n = 8) and age-and sex-matched controls (n = 10). Analyses were performed with the Olink technology simultaneously measuring 184 biomarkers of cardiovascular disease. For bioinformatics, acquired data were analyzed using gene set enrichment analysis (GSEA). Selected proteins were validated using ELISA. Individual receiver operating characteristic (ROC) curves and odds ratios from logistic regression were calculated. A randomForest (RF) model with out-of-bag estimate was applied for predictive modeling. Results: GSEA indicated enrichment of proteins related to inflammatory response in the AF group. Interleukin (IL)-6, growth differentiation factor (GDF)-15, and pentraxin-related protein PTX3 were the top biomarkers on the ranked list for the AF group compared to the LAA group and the control group. ELISA validated increased expression of all tested proteins (GDF-15, PTX3, and urokinase plasminogen activator surface receptor [U-PAR]), except for IL-6. 19 proteins had the area under the ROC curve (AUC) over 0.85 including all of the proteins with significant evolution in the logistic regression. AUCs were very discriminant in distinguishing patients with and without AF (LAA and control group together). GDF-15 alone reached AUC of 0.95. Based on RF model, all selected participants in the tested group were classified correctly, and the most important protein in the model was GDF-15. Conclusions: Our results demonstrate an association between inflammation and AF and that multiple proteins alone and in combination may potentially be used as indicators of AF in CS and TIA patients. However, further studies including larger samples sizes are needed to support these findings. In the ongoing NOR-FIB study, we plan further biomarker assessments in patients with CS and TIA undergoing long-term cardiac rhythm monitoring with insertable cardiac monitors.

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Section: Introductionmentioning

confidence: 99%

Biomarkers Associated with Atrial Fibrillation in Patients with Ischemic Stroke: A Pilot Study from the NOR-FIB Study

Lambert¹,

Kong²,

Ratajczak-Tretel³

et al. 2020

Cerebrovasc Dis Extra

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“…It is desirable that ECG monitoring initiated shortly after ESUS be prolonged, especially in the subpopulation with additional signs of atrial disease [17][18][19][20][21][22]. Supplementary diagnostic procedures should be initiated as soon as possible following the occurrence of stroke, in order to maximise the benefits of potentially indicated anticoagulation.…”

Section: Therapeutic Problemmentioning

confidence: 99%

“…In current clinical practice, prolonged ECG monitoring after a stroke is rare, and qualification for such monitoring is highly individualised [19]. Such practice results from limited financial and human resources and definitely brings no benefit on the level of public health [19]. On the other hand, the high direct cost of prolonged ECG monitoring require the proper selection of patients to maximise the proportion of screenings yielding positive results.…”

Section: Ecg Monitoringmentioning

confidence: 99%

Statement by a Working Group conceived by the Polish National Consultants in Cardiology and Neurology addressing the use of implantable cardiac monitors in patients after ischaemic embolic stroke of undetermined source

Farkowski

Karliñski

Kaźmierczak

et al. 2018

Neurol Neurochir Pol.

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Introduction. Stroke remains one of the main causes of death and the most common cause of long-term disability in adults. Embolic strokes of undetermined source (ESUS) amount to a significant proportion of all ischaemic strokes. Detection of atrial fibrillation (AF) in this group of patients would allow for a major therapeutic decision to switch from antiplatelets to oral anticoagulants and therefore significantly reduce the risk of recurrence. State of the Art. Current technology allows long-term continuous ECG monitoring with different systems, including implantable cardiac monitors (ICM). However, in Poland lack of reimbursement does not allow their use in everyday clinical practice. Clinical Implications. This is a statement by a Working Group conceived by the Polish National Consultants in Cardiology and Neurology addressing the use of ICM in patients after ischaemic embolic strokes of undetermined source. The aim was to develop reasonable and comprehensive guidance on how to select and manage candidates for ICM in order to obtain the maximum benefit for Polish public health. Future Directions. This expert opinion is not intended as a guideline but it provides advice as to how to optimise the potential use of ICM in patients after ESUS in the Polish setting.

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“…Sources for cardioembolism are further classified into major-or minor-risk sources according to their (thrombo-) embolic potential [3]. The most common major-risk source of cardioembolism is atrial fibrillation (AF) [4]. Less frequent major-risk sources are cardiomyopathies with left ventricular (LV) dysfunction, intracardiac thrombi, cardiac tumors, prosthetic valves, and endocarditis [3] (Fig.…”

Section: Introductionmentioning

confidence: 99%

“…Cardiac work-up after stroke might lead to changes in secondary stroke prevention, guide screening for atrial fibrillation, and serve as a screening tool for (coronary) heart disease given the strong overlap of cerebrovascular and cardiovascular risk factors [11,12]. While screening for AF after stroke has become common practice, cardiac imaging after ischemic stroke is less well established [4,11,13].…”

Section: Introductionmentioning

confidence: 99%

Cardiac Imaging After Ischemic Stroke or Transient Ischemic Attack

Camen

Hæusler

Schnabel

2020

Curr Neurol Neurosci Rep

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Purpose of Review Cardiac imaging after ischemic stroke or transient ischemic attack (TIA) is used to identify potential sources of cardioembolism, to classify stroke etiology leading to changes in secondary stroke prevention, and to detect frequent comorbidities. This article summarizes the latest research on this topic and provides an approach to clinical practice to use cardiac imaging after stroke. Recent Findings Echocardiography remains the primary imaging method for cardiac work-up after stroke. Recent echocardiography studies further demonstrated promising results regarding the prediction of non-permanent atrial fibrillation after ischemic stroke. Cardiac magnetic resonance imaging and computed tomography have been tested for their diagnostic value, in particular in patients with cryptogenic stroke, and can be considered as second line methods, providing complementary information in selected stroke patients. Summary Cardiac imaging after ischemic stroke or TIA reveals a potential causal condition in a subset of patients. Whether systematic application of cardiac imaging improves outcome after stroke remains to be established.

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Detection of Atrial Fibrillation in Cryptogenic Stroke

Cited by 36 publications

References 53 publications

Biomarkers Associated with Atrial Fibrillation in Patients with Ischemic Stroke: A Pilot Study from the NOR-FIB Study

Biomarkers Associated with Atrial Fibrillation in Patients with Ischemic Stroke: A Pilot Study from the NOR-FIB Study

Statement by a Working Group conceived by the Polish National Consultants in Cardiology and Neurology addressing the use of implantable cardiac monitors in patients after ischaemic embolic stroke of undetermined source

Cardiac Imaging After Ischemic Stroke or Transient Ischemic Attack

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