Predictors of Atrial Fibrillation in Patients With Cryptogenic Stroke

Abstract

Background and Purpose: Many patients diagnosed with cryptogenic stroke or transient ischemic attack are subsequently found to have atrial fibrillation (AF) on outpatient cardiac telemetry monitoring. Identification of predictive factors for the detection of AF could assist with patient selection to increase the yield of telemetry and hasten initiation of appropriate secondary stroke prevention. Methods: This was a retrospective cross-sectional study of patients diagnosed with cryptogenic stroke at a comprehensive stroke center and referred for at least 21 days of prolonged outpatient telemetry. Telemetry reports and data from the patient's stroke hospitalization, including imaging studies, electrocardiogram (EKG), echocardiogram, vital signs, and laboratory data, were reviewed. Results: Ten percent of the 121 patients included in the study were diagnosed with AF based on outpatient telemetry. There was a strong association between presence of premature atrial contractions (PACs) on admission EKG and subsequent detection of AF (P ¼ .004). Large left atrial diameter on echocardiogram was correlated with AF detection in males (P ¼ .024). However, there was no association between AF and other echocardiographic measurements. Thyroid-stimulating hormone (TSH) levels were significantly higher in patients with cryptogenic stroke having AF (P ¼ .008), with a TSH greater than 4.20 mIU/L predictive of detection of AF (P < .001). Conclusions: Atrial fibrillation was found by outpatient monitoring in a notable percentage of patients with cryptogenic stroke. Predictors of occult AF in our study population included PACs and higher TSH levels. Although an association between low TSH and AF has been well established, our results suggest that high TSH may be a predictive factor as well.

Predictors of Atrial Fibrillation Development in Patients With Embolic Stroke of Undetermined Source: An Analysis of the RE-SPECT ESUS Trial

“…Using the RE-SPECT ESUS data of 5390 patients with ESUS, 7.5% developed AF. The incidence is lower than in some of the smaller studies 9,13,14 but similar to the incidence described in the retrospective cohort study from the STRIDE database where the HAVOC score was derived and validated. 4 We also tested the HAVOC score performance in the RE-SPECT ESUS population and, as expected, the higher the score, the greater the risk of AF development.…”

“…Several different scores have been developed to predict AF after stroke 9,[11][12][13][14] ; however, these studies have several limitations attributable to small sample size, short monitoring period, difficulty in data acquisition, or poor applicability to the population with cryptogenic stroke.…”

Atrial fibrillation: villain or bystander in vascular brain injury

“…Markers of hypercoagulability have been related to post-stroke AF, 171 , 172 or, more generally, thyroid-stimulating hormone. 162 Cardiac biomarkers including troponins and natriuretic peptides as markers of cardiac stress are associated with thrombo-embolic propensity. 173 NT-proBNP is strongly associated with post-stroke AF and could to be used to guide the intensity of post-stroke AF-search.…”

Application of transesophageal echocardiography, left atrial appendage angiography, cardiac computed tomography angiography, and three-dimensional reconstruction model in left atrial appendage occlusion

“…1 Stroke is a common complication of AF and often leads to death or disability in patients, causing serious burden to the patients' families and the society. 2,3 Prevention of stroke in patients with AF is currently one of the key strategies. 4,5 Due to low compliance and risk of bleeding, the clinical application of oral anticoagulants is limited.…”

“…4,5 Due to low compliance and risk of bleeding, the clinical application of oral anticoagulants is limited. [6][7][8] Therefore, exploring new strategies to prevent stroke in patients with AF has become one of the present highly discussed topics in clinical research. Transcatheter closure of the left atrial appendage (LAA) has been used clinically as a new technique to prevent stroke in patients with nonvalvular AF.…”