Incremental value of the combined brain-cardiac CT protocol on prediction of atrial fibrillation after stroke

Braillon, Alexandra; Bernard, Angélique; Leclercq, Thibault; Duloquin, Gauthier; Pommier, Thibaut; Bénali, Karim; Comby, Pierre-Olivier; Loffroy, Romaric; Midulla, Marco; Ricolfi, F.; Béjot, Yannick; Guenancia, Charles

doi:10.1177/23969873221138197

Cited by 6 publications

(5 citation statements)

References 29 publications

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“…Tachycardia-associated arrhythmias, especially AF, are more frequent than bradycardias [15,26]. The incidence of AF following AIS is approximately 5-24% [21][22][23][24]. Consistent with the above-mentioned results, the incidence of AF detected after stroke (AFDAS) was higher in strokes involving the right insula (39%) than in strokes involving the left insula (4%) [61].…”

Section: Electrocardiographic Changes and Cardiac Arrhythmiasmentioning

confidence: 59%

Stroke–heart syndrome: current progress and future outlook

Wang,

Ma,

Ren

et al. 2024

J Neurol

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Stroke can lead to cardiac complications such as arrhythmia, myocardial injury, and cardiac dysfunction, collectively termed stroke–heart syndrome (SHS). These cardiac alterations typically peak within 72 h of stroke onset and can have long-term effects on cardiac function. Post-stroke cardiac complications seriously affect prognosis and are the second most frequent cause of death in patients with stroke. Although traditional vascular risk factors contribute to SHS, other potential mechanisms indirectly induced by stroke have also been recognized. Accumulating clinical and experimental evidence has emphasized the role of central autonomic network disorders and inflammation as key pathophysiological mechanisms of SHS. Therefore, an assessment of post-stroke cardiac dysautonomia is necessary. Currently, the development of treatment strategies for SHS is a vital but challenging task. Identifying potential key mediators and signaling pathways of SHS is essential for developing therapeutic targets. Therapies targeting pathophysiological mechanisms may be promising. Remote ischemic conditioning exerts protective effects through humoral, nerve, and immune-inflammatory regulatory mechanisms, potentially preventing the development of SHS. In the future, well-designed trials are required to verify its clinical efficacy. This comprehensive review provides valuable insights for future research.

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Section: Electrocardiographic Changes and Cardiac Arrhythmiasmentioning

confidence: 59%

Stroke–heart syndrome: current progress and future outlook

Wang,

Ma,

Ren

et al. 2024

J Neurol

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“…The predictive value of left atrial dilatation has already been demonstrated in our previous work on the role of cardiac CT angiography in the acute stroke imaging protocol. 34 These results taken together suggest that AC as defined in ARCADIA trial may lack sensitivity and specificity to target the patients who will benefit from an anticoagulant therapy.…”

Section: Discussionmentioning

confidence: 97%

Distribution of atrial cardiomyopathy markers and association with atrial fibrillation detected after ischaemic stroke in the SAFAS study

Didier

Garnier²,

Duloquin³

et al. 2023

Stroke Vasc Neurol

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BackgroundAtrial cardiomyopathy (AC) is an emerging concept explaining the pathophysiology of cardioembolic strokes in absence of atrial fibrillation (AF). A definition based on the presence of electrical abnormality (P-wave terminal force in lead V1 (PTFV1) >5000 µV×ms), N-Terminal pro-B-type natriuretic peptide (NT pro BNP) >250 pg/mL and/or indexed left atrial diameter (LADI) >3 cm/m² is currently tested in the ARCADIA (AtRial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenic stroke) trial. We set out to estimate the prevalence of AC as defined in the ARCADIA trial, its determinants and its association with AF detected after stroke (AFDAS).MethodsStepwise screening for silent Atrial Fibrillation After Stroke (SAFAS) study prospectively included 240 ischaemic stroke patients. AC markers were complete for 192 of them and 9 were not included in this analysis because AF had been diagnosed on admission.ResultsA total of 183 patients were analysed, of whom 57% (104 patients) met the AC criteria (79 NT-proBNP, 47 PTFV1, 4 LADI). In the multivariate logistic regression, C reactive protein >3 mg/L (OR (95% CI) 2.60 (1.30 to 5.21), p=0.007) and age (OR (95% CI) 1.07 (1.04 to 1.10), p<0.001) were found to be independently associated with AC. After 6 months of follow-up, AFDAS was detected in 33% of AC patients and in 14% of the remaining ones (p=0.003). However, AC was not independently associated with AFDAS, contrary to left atrial volume index (>34 mL/m2, OR 2.35 (CI 1.09 to 5.06) p=0029).ConclusionAC as defined in ARCADIA is mostly based on NT pro BNP elevation (76% of patients) and is associated with age and inflammation. Moreover, AC was not independently associated with AFDAS at follow-up. The ARCADIA trial, which compares aspirin to apixaban in patients with embolic strokes of undetermined source with AC markers and must, therefore be analysed in the light of these limitations.Trial registration numberNCT03570060.

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“… 1 , 5 , 7 , 21 Information on acute cardiac CT may also be used to predict occurrence of atrial fibrillation in patients with stroke. 22 …”

Section: Discussionmentioning

confidence: 99%

Long‐Term Clinical Implications of High‐Risk Cardiac Computed Tomography Findings in Patients With Acute Ischemic Stroke

Rinkel,

Cramer,

Özata

et al. 2024

JAHA

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Background Cardiac computed tomography (CT) acquired during the initial acute stroke imaging protocol (acute cardiac CT) is increasingly used to screen for cardioembolism, but information on the long‐term clinical implications of its findings is lacking. Methods and Results We performed a prospective, single‐center cohort study in which consecutive patients with ischemic stroke underwent ECG‐gated acute cardiac CT and were followed up for 2 years. The primary outcome was functional outcome assessed using the modified Rankin Scale. Secondary outcomes were death and occurrence of major adverse cardiovascular events (composite of recurrent ischemic stroke, myocardial infarction, and cardiovascular death). We compared patients with and without a high‐risk structural source of embolism on acute cardiac CT. Of 452 included patients, 55 (12.2%) had a high‐risk source of embolism, predominantly cardiac thrombi (38 patients) and signs of endocarditis (8 patients). Follow‐up at 2 years was complete for 430 (95.1%) patients. Patients with a high‐risk source of embolism had a worse functional outcome (median modified Rankin Scale, 6 [IQR, 2–6] versus 2 [IQR, 1–5]; adjusted common odds ratio, 2.92 [95% CI, 1.62–5.25]), increased mortality rate (52.7% versus 23.7%; adjusted hazard ratio [HR], 3.28 [95% CI, 1.94–5.52]), and major adverse cardiovascular events (38.9% versus 17.5%; adjusted HR, 3.20 [95% CI, 1.80–5.69]). A high‐risk source of embolism was not associated with recurrent ischemic stroke (11.1% versus 9.6%; adjusted HR, 1.30 [95% CI, 0.49–3.44]). Conclusions Structural high‐risk sources of embolism on acute cardiac CT in patients with ischemic stroke were associated with poor long‐term functional outcome and occurrence of major adverse cardiovascular events but not with recurrent stroke.

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Incremental value of the combined brain-cardiac CT protocol on prediction of atrial fibrillation after stroke

Cited by 6 publications

References 29 publications

Stroke–heart syndrome: current progress and future outlook

Stroke–heart syndrome: current progress and future outlook

Distribution of atrial cardiomyopathy markers and association with atrial fibrillation detected after ischaemic stroke in the SAFAS study

Long‐Term Clinical Implications of High‐Risk Cardiac Computed Tomography Findings in Patients With Acute Ischemic Stroke

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