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Observational Study
. 2023 Aug;270(8):4049-4059.
doi: 10.1007/s00415-023-11680-8. Epub 2023 May 10.

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

B Ratajczak-Tretel  1   2 , A Tancin Lambert  1   2 , R Al-Ani  3 , K Arntzen  4 , G K Bakkejord  4 , H M O Bekkeseth  5 , V Bjerkeli  6 , G Eldøen  7 , A K Gulsvik  8 , B Halvorsen  6 , G A Høie  3 , H Ihle-Hansen  9 , H Ihle-Hansen  10 , S Ingebrigtsen  11 , C Kremer  12   13 , S B Krogseth  14 , C Kruuse  15 , M Kurz  16 , I Nakstad  17 , V Novotny  18 , H Næss  18 , R Qazi  8 , M K Rezaj  16 , D M Rørholt  7 , L H Steffensen  11 , J Sømark  5 , H Tobro  19 , T C Truelsen  20 , L Wassvik  21 , K L Ægidius  21 , D Atar  2   22 , Anne Hege Aamodt  23   24 ; NOR-FIB study group
Affiliations
Observational Study

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

B Ratajczak-Tretel et al. J Neurol. 2023 Aug.

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.

Keywords: Atrial fibrillation; Biomarkers; Cryptogenic stroke; ICM; Prediction scores; Predictors.

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Conflict of interest statement

AHA has received travel support, and honoraria for advice or lecturing from Bayer, Boehringer Ingelheim, BMS, Abbvie, Teva, Novartis, Roche, Pfizer, and Teva, research grant from Boehringer Ingelheim. DA has received honoraria and consultation fees from Actelion, Amgen, AstraZeneca, BMS/Pfizer, Bayer, Boehringer-Ingelheim, MSD, Novartis, Pharmacosmos, Roche Diagnostics, Sanofi, Takeda, and Vifor Pharma, and research funding (to the institution) from BMS/Pfizer, Bayer, Roche Diagnostics and Medtronic. BRT and ATL have received travel funding from Medtronic.

Figures

Fig. 1
Fig. 1
Utility of the eight clinical scores in the NOR-FIB study predicting AF in CS and TIA patients. AUC for continuous score values. Similar AUC results were obtained also when corrected for the n difference between score (all scores tested simultaneously): AS5F 0.719, Brown ESUS-AF 0.674, CHA2DS2-VASc 0.674, CHASE-LESS 0.664, HATCH 0.639, HAVOC 0.659, STAF 0.673, SURF 0.736
Fig. 2
Fig. 2
Overview of the cardiac sources of embolism structured after The Stop Stroke TOAST system [49]. AF: atrial fibrillation, PAF: paroxysmal AF, LA: left atrium, LV: left ventricle, MI: myocardial infarction, cMI: chronic myocardial infarction, CHF: congestive heart failure, EF: Left ventricular ejection fraction, TOAST: the Trial of Org 10,172 in Acute Stroke Treatment
See this image and copyright information in PMC

References

    1. Yaghi S, Bernstein RA, Passman R, Okin PM, Furie KL. Cryptogenic stroke: research and practice. Circ Res. 2017;120(3):527–540. doi: 10.1161/CIRCRESAHA.116.308447. - DOI - PubMed
    1. Tsivgoulis G, Triantafyllou S, Palaiodimou L, Grory BM, Deftereos S, Köhrmann M, Dilaveris P, Ricci B, Tsioufis K, Cutting S, Magiorkinis G, Krogias C, Schellinger PD, Dardiotis E, Rodriguez-Campello A, Cuadrado-Godia E, Aguiar de Sousa D, Sharma M, Gladstone DJ, Sanna T, Wachter R, Furie KL, Alexandrov AV, Yaghi S, Katsanos AH. Prolonged cardiac monitoring and stroke recurrence: a meta-analysis. Neurology. 2022;98(19):e1942–e1952. doi: 10.1212/WNL.0000000000200227. - DOI - PubMed
    1. Sposato LA, Andrade J. Prolonged cardiac monitoring for atrial fibrillation detection after stroke: in search of the elusive sweet spot. Neurology. 2022;98(19):781–783. doi: 10.1212/WNL.0000000000200333. - DOI - PubMed
    1. Lu Y, Diao SS, Huang SJ, Zhao JJ, Ye MF, Yao FR, Kong Y, Xu Z. Insertable cardiac monitors for detection of atrial fibrillation after cryptogenic stroke: a meta-analysis. Neurol Sci. 2021;42(10):4139–4148. doi: 10.1007/s10072-021-05104-6. - DOI - PubMed
    1. Cuadrado-Godia E, Benito B, Ois A, Vallès E, Rodríguez-Campello A, Giralt-Steinhauer E, Cabrera S, Alcalde O, Jiménez-López J, Jiménez-Conde J, Martí-Almor J, Roquer J. Ultra-early continuous cardiac monitoring improves atrial fibrillation detection and prognosis of patients with cryptogenic stroke. Eur J Neurol. 2020;27(2):244–250. doi: 10.1111/ene.14061. - DOI - PubMed

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