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

Abstract

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.

Heart rate turbulence in acute ischemic stroke

“…The CHA 2 DS 2 -VASc score is easily calculated, commonly used in clinical practice and has also been utilized for the prediction of AF in cryptogenic stroke although performance for predicting AF is only modest. 22 , 23 The analysis examining the association between HRT and focal myocardial fibrosis (presence of LGE on CMR) was adjusted for age, sex, hypertension, diabetes, and previous stroke. For the endpoint LGE on CMR, all patients with a known history of myocardial infarction were excluded before analysis to limit the results to patients with previously unknown myocardial fibrosis.…”

Predictive value of right heart contrast echocardiography combined with STAF in cardioembolism

“…Initially designed for atrial fibrillation screening, STAF incorporates various risk factors associated with atrial fibrillation-related stroke, including age, left atrial diameter, National Institutes of Health Stroke Scale (NIHSS) score, and vascular etiology. Ongoing research has also affirmed its applicability in the diagnosis of cerebral infarction in addition to screening atrial fibrillation [7][8][9]. Based on this, we designed this present study to investigate the predictive value of right heart contrast echocardiography combined with STAF for CE in diagnosing CE.…”