Pathophysiology and Risk of Atrial Fibrillation Detected after Ischemic Stroke (PARADISE): A Translational, Integrated, and Transdisciplinary Approach

Paquet, Maryse; Cerasuolo, Joshua O.; Thorburn, Victoria; Fridman, Sebastián; Alsubaie, Rasha; Lópes, Renato D.; Cipriano, Lauren E.; Salamone, Paula; Melling, C.W. James; Khan, Ali R.; Sedeño, Lucas; Fang, Jiming; Drangova, Maria; Montero‐Odasso, Manuel; Mandzia, Jennifer; Khaw, Alexander V.; Racosta, Juan Manuel; Paturel, Justin R.; Samoilov, Lucy; Stirling, Devin; Balint, Brittany; Jaremek, Victoria; Koschinsky, Marlys L.; Boffa, Michael B.; Summers, Kelly L.; Ibáñez, Agustín; Mrkobrada, Marko; Saposnik, Gustavo; Kimpinski, Kurt; Whitehead, Shawn N.; Sposato, Luciano A.

doi:10.1016/j.jstrokecerebrovasdis.2017.09.038

“…This study found that atrial fibrillation was associated with a higher risk of stroke in patients with vertigo diagnosed with stroke. Long-term atrial fibrillation will produce mural thrombus, which will enter the brain with blood flow after falling off, resulting in ischemic stroke [10,11]. After analyzing the data of Denmark, Christiansen et al [12] found that the incidence of stroke with atrial fibrillation in the 50-year-old population was 1.1%.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors and Risk Model Construction of Stroke in Patients with Vertigo in Emergency Department

Zhu

¹

,

Li

²

,

Wang

³

et al. 2022

Computational and Mathematical Methods in Medicine

0

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Objective. We aimed to explore the risk factors of stroke in patients with vertigo in the emergency department and establish a risk prediction model for stroke patients. Methods. A total of 301 patients experiencing vertigo in our hospital from January 2020 to January 2021 were retrospectively included. Patients were divided into the stroke group ( n = 56 ) and the nonstroke group ( n = 245 ). The clinical characteristics of patients in both groups were collected and compared, followed by binary logistic regression that was employed to determine the risk factors that affect stroke diagnosis. The receiver operating characteristic (ROC) curve was used to clarify the effectiveness of the constructed model. Results. Patients in the stroke group were older and had higher systolic and diastolic blood pressure on admission than the nonstroke group. Meanwhile, they demonstrated a higher proportion of diabetes and atrial fibrillation and focal muscle weakness, dysarthria, dysphagia, or ataxia in neurological examinations compared to the nonstroke group (all P < 0.05 ). The proportion of patients in the nonstroke group who had a history of vertigo or inner ear disease was significantly higher than that in the stroke group ( P < 0.05 ). The patient’s age ≥ 60 years old ( OR = 3.57 ), diabetes ( OR = 4.57 ), atrial fibrillation ( OR = 4.26 ), previous history of vertigo or inner ear disease ( OR = 0.16 ), focal muscle weakness ( OR = 4.34 ), and dysphagia or ataxia ( OR = 4.08 ) were associated with a higher risk of stroke. The area under the curve for stroke was 0.87, and the sensitivity and specificity were 98.2% and 57.6%, respectively, as the sum of the assigned scores was greater than 3. Conclusions. Age ≥ 60 years old, diabetes, atrial fibrillation, previous history of vertigo or inner ear disease, focal muscle weakness, dysphagia, or ataxia were associated with a higher risk of stroke. The risk model constructed based on our findings may help to assess the risk of stroke in patients with vertigo in the emergency department.

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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%

“… 24 , 26 Several randomised studies evaluating these markers of atrial cardiopathy are currently in progress. 52 – 54 …”

Section: Discussionmentioning

confidence: 99%

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

Ward

¹

,

Vail

²

,

Cameron

³

et al. 2022

European Stroke Journal

2

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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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“…On the other hand, systemic risk factors participate to increase risk of stroke via non atrium-related mechanisms, such as in situ cerebral small-vessel occlusion, atherosclerosis of the large-artery, and ventricular systolic dysfunction [60]. Finally, once stroke occurs, AF risk may transiently increase because of autonomic changes and post-stroke inflammation [61].…”

Section: Current “Views” On Atrial Fibrillation-related Strokementioning

confidence: 99%

Cognitive Function and Atrial Fibrillation: From the Strength of Relationship to the Dark Side of Prevention. Is There a Contribution from Sinus Rhythm Restoration and Maintenance?

Gallinoro

¹

,

D’Elia

²

,

Prozzo

³

et al. 2019

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Atrial fibrillation (AF) is the most common chronic cardiac arrhythmia with an increasing prevalence over time mainly because of population aging. It is well established that the presence of AF increases the risk of stroke, heart failure, sudden death, and cardiovascular morbidity. In the last two decades several reports have shown an association between AF and cognitive function, ranging from impairment to dementia. Ischemic stroke linked to AF is a well-known risk factor and predictor of cognitive decline. In this clinical scenario, the risk of stroke might be reduced by oral anticoagulation. However, recent data suggest that AF may be a predictor of cognitive impairment and dementia also in the absence of stroke. Cerebral hypoperfusion, reduced brain volume, microbleeds, white matter hyperintensity, neuroinflammation, and genetic factors have been considered as potential mechanisms involved in the pathogenesis of AF-related cognitive dysfunction. However, a cause-effect relationship remains still controversial. Consequently, no therapeutic strategies are available to prevent AF-related cognitive decline in stroke-free patients. This review will analyze the potential mechanisms leading to cognitive dysfunction in AF patients and examine the available data on the impact of a sinus rhythm restoration and maintenance strategy in reducing the risk of cognitive decline.

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Pathophysiology and Risk of Atrial Fibrillation Detected after Ischemic Stroke (PARADISE): A Translational, Integrated, and Transdisciplinary Approach

Cited by 12 publications

References 60 publications

Risk Factors and Risk Model Construction of Stroke in Patients with Vertigo in Emergency Department

Risk Factors and Risk Model Construction of Stroke in Patients with Vertigo in Emergency Department

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

Cognitive Function and Atrial Fibrillation: From the Strength of Relationship to the Dark Side of Prevention. Is There a Contribution from Sinus Rhythm Restoration and Maintenance?

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