Paroxysmal atrial fibrillation in young cryptogenic ischemic stroke: A 3-week ECG Holter monitoring study

Šaňák, Daniel; Hutyra, Martin; Král, Michal; Bártková, Andrea; Zapletalová, Jana; Fedorco, Marián; Veverka, Tomáš; Vindiš, David; Dorňák, Tomáš; Škála, Tomáš; Školoudík, David; Táborský, Miloš; Kaňovský, Petr

doi:10.5507/bp.2015.019

Cited by 21 publications

(31 citation statements)

References 37 publications

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“…There were six studies of the diagnostic validity of BNP (n=1930) [29][30][31][32][33][34] and three for NT-proBNP (n=623) [35][36][37] (online supplemental figure I). There was 97.8% agreement between the investigators for study inclusion (κ=0.86).…”

Section: Resultsmentioning

confidence: 99%

Cardiac natriuretic peptides for diagnosis of covert atrial fibrillation after acute ischaemic stroke: a meta-analysis of diagnostic accuracy studies

Zhang

Kamtchum‐Tatuene

et al. 2020

Stroke Vasc Neurol

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Background and purposeDetection of atrial fibrillation (AF) after acute ischaemic stroke is pivotal for the timely initiation of anticoagulation to prevent recurrence. Besides heart rhythm monitoring, various blood biomarkers have been suggested as complimentary diagnostic tools for AF. We aimed to summarise data on the performance of cardiac natriuretic peptides for the diagnosis of covert AF after acute ischaemic stroke and to assess their potential clinical utility.MethodsWe searched PubMed and Embase for prospective studies reporting the performance of B-type natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP) for the diagnosis of covert AF after acute ischaemic stroke. Summary diagnostic performance measures were pooled using bivariate meta-analysis with a random-effect model.ResultsWe included six studies focusing on BNP (n=1930) and three studies focusing on NT-proBNP (n=623). BNP had a sensitivity of 0.83 (95% CI 0.64 to 0.93), a specificity of 0.74 (0.67 to 0.81), a positive likelihood ratio of 3.2 (2.6 to 4.0) and a negative likelihood ratio of 0.23 (0.11 to 0.49). NT-proBNP had a sensitivity of 0.91 (0.65 to 0.98), a specificity of 0.77 (0.52 to 0.91), a positive likelihood ratio of 3.9 (1.8 to 8.7) and a negative likelihood ratio of 0.12 (0.03 to 0.48). Considering a pretest probability of 20%, BNP and NT-proBNP had post-test probabilities of 45% and 50%.ConclusionsNT-proBNP has a better performance than BNP for the diagnosis of covert AF after acute ischaemic stroke. Both biomarkers have low post-test probabilities and may not be used as a stand-alone decision-making tool for the diagnosis of covert AF in patients with acute ischaemic stroke. However, they may be useful for a screening strategy aiming to select patients for long-term monitoring of the heart rhythm.

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Section: Resultsmentioning

confidence: 99%

Cardiac natriuretic peptides for diagnosis of covert atrial fibrillation after acute ischaemic stroke: a meta-analysis of diagnostic accuracy studies

Zhang

Kamtchum‐Tatuene

et al. 2020

Stroke Vasc Neurol

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“… 1) Cardio-embolic stroke is the most frequently predicted cause of cryptogenic stroke; the most frequent cause of cerebral cardio-embolism is atrial fibrillation (AF), including paroxysmal AF. 2) AF is the most common etiology of ischemic stroke; the incidence of stroke in individuals with non-valvular AF is estimated to be 5 times higher than in individuals without AF. 3) The prevalence of AF in the whole stroke population has been reported to range from 17%−25.6%.…”

Section: Introductionmentioning

confidence: 99%

Epicardial Fat Thickness and Free Fatty Acid Level are Predictors of Acute Ischemic Stroke with Atrial Fibrillation

Cho

Lee

et al. 2018

J Cardiovasc Imaging

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BACKGROUNDIncreased epicardial fat is known to be associated with the presence and chronicity of atrial fibrillation (AF). Free fatty acids (FFAs) are major components of epicardial fat; however, their potential association with AF in ischemic stroke has not been investigated. We aimed to assess the performance of echocardiographic epicardial fat thickness (EFT) and plasma FFA level in identifying patients with ischemic stroke and AF.METHODSWe enrolled a total of 214 consecutive patients (mean age, 66.8 ± 12.3 years; 39.7% women) diagnosed with acute ischemic stroke between March 2011 and June 2014. The patients were divided into two groups: ischemic stroke with AF (n = 35, 16.4%) and ischemic stroke without AF (n = 179, 83.6%).RESULTSThe ischemic stroke with AF group showed significantly higher serum FFA level (1379.7 ± 717.5 vs. 757.8 ± 520.5 uEq/L, p < 0.0001) and EFT (6.5 ± 1.2 vs. 5.3 ± 1.2 mm, p < 0.001) than the group without AF. Multivariable logistic regression analysis demonstrated that age (odds ratio [OR], 1.112), serum FFA level (OR, 1.002), and EFT (OR, 1.740) were independently associated with the ischemic stroke group with AF. EFT and FFA significantly improved the goodness-of-fit and discriminability of the simple regression model including age as a covariate (log likelihood difference, 21.35; p < 0.001; c-index difference, 17.9%; p < 0.001).CONCLUSIONSHigh EFT and serum FFA level were associated with ischemic stroke in patients with AF. Echocardiographic EFT and serum FFA level can play a significant role in identifying ischemic stroke with AF.

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“…The authors detected PAF by extended Holter in 9.5% of this sample. 13 Patients with PAF detected during follow-up had elevated baseline serum levels of hs-cTnT, defined as ≥14 ng/L, significantly more frequently than patients without detected AF (56% vs 2%, p = 0.0001). 13 A similar trend was seen with NT-pro-BNP (56% vs 3.5%, p = 0.0001).…”

Section: Atrial Fibrillationmentioning

confidence: 87%

“…13 Patients with PAF detected during follow-up had elevated baseline serum levels of hs-cTnT, defined as ≥14 ng/L, significantly more frequently than patients without detected AF (56% vs 2%, p = 0.0001). 13 A similar trend was seen with NT-pro-BNP (56% vs 3.5%, p = 0.0001). Hence, elevated admission hs-cTn in patients with cryptogenic ischemic stroke may identify patients who require prolonged surveillance for PAF.…”

Section: Atrial Fibrillationmentioning

confidence: 87%

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High-Sensitivity Troponin as a Biomarker in Heart Rhythm Disease

McCarthy

Yousuf

Alonso

et al. 2017

The American Journal of Cardiology

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Biomarkers are important prognostic tools in various cardiovascular conditions, including coronary artery disease and heart failure. Although their utility in cardiac electrophysiology (EP) is less established, biomarkers may guide EP clinical practice by identifying patients at risk for developing arrhythmias and their complications, in addition to augmenting therapeutic decisions by targeting appropriate pharmacologic and interventional therapies to patients who may benefit most. In this review, we focus on the prognostic role of high-sensitivity cardiac troponin (hs-cTn) assays—which detect subclinical cardiac myocyte damage—in cardiac arrhythmias and their sequelae. We review the current literature on hs-cTn and its impact on various arrhythmia disease states and also provide suggestions for future research in this field. In conclusion, although the utility of hs-cTn assays remains at an investigational stage in cardiac EP, studies to date have suggested value as a prognostic biomarker in atrial fibrillation and as a screening marker for patients at high risk of sudden cardiac death (both in the general population and among those with hypertrophic cardiomyopathy).

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Paroxysmal atrial fibrillation in young cryptogenic ischemic stroke: A 3-week ECG Holter monitoring study

Cited by 21 publications

References 37 publications

Cardiac natriuretic peptides for diagnosis of covert atrial fibrillation after acute ischaemic stroke: a meta-analysis of diagnostic accuracy studies

Cardiac natriuretic peptides for diagnosis of covert atrial fibrillation after acute ischaemic stroke: a meta-analysis of diagnostic accuracy studies

Epicardial Fat Thickness and Free Fatty Acid Level are Predictors of Acute Ischemic Stroke with Atrial Fibrillation

High-Sensitivity Troponin as a Biomarker in Heart Rhythm Disease

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