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

Autor: Ratajczak-Tretel B; Department of Neurology, Østfold Hospital Trust, Grålum, Norway.; Institute of Clinical Medicine, University of Oslo, Oslo, Norway., Lambert AT; Department of Neurology, Østfold Hospital Trust, Grålum, Norway.; Institute of Clinical Medicine, University of Oslo, Oslo, Norway., Al-Ani R; Department of Cardiology, Østfold Hospital Trust, Grålum, Norway., Arntzen K; Department for Neurology, Nordlandssykehuset, Bodø, Norway., Bakkejord GK; Department for Neurology, Nordlandssykehuset, Bodø, Norway., Bekkeseth HMO; Department of Neurology, Innlandet Hospital Trust, Lillehammer Hospital, Lillehammer, Norway., Bjerkeli V; Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway., Eldøen G; Department of Neurology, Molde Hospital, Molde, Norway., Gulsvik AK; Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway., Halvorsen B; Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway., Høie GA; Department of Cardiology, Østfold Hospital Trust, Grålum, Norway., Ihle-Hansen H; Stroke Unit, Oslo University Hospital, Ullevål, Oslo, Norway., Ihle-Hansen H; Department of Internal Medicine, Vestre Viken Hospital Trust, Bærum Hospital, Gjettum, Norway., Ingebrigtsen S; Department of Neurology, University Hospital of North Norway, Tromsø, Norway., Kremer C; Department of Neurology, Skåne University Hospital, Malmö, Sweden.; Department of Clinical Sciences, Lund University, Lund, Sweden., Krogseth SB; Department of Neurology, Vestfold Hospital, Tønsberg, Norway., Kruuse C; Department of Neurology, Herlev Gentofte Hospital, Herlev, Denmark., Kurz M; Department of Neurology, Stavanger University Hospital, Stavanger, Norway., Nakstad I; Department of Neurology, Vestre Viken Hospital Trust, Drammen Hospital, Drammen, Norway., Novotny V; Department of Neurology, Haukeland University Hospital, Bergen, Norway., Næss H; Department of Neurology, Haukeland University Hospital, Bergen, Norway., Qazi R; Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway., Rezaj MK; Department of Neurology, Stavanger University Hospital, Stavanger, Norway., Rørholt DM; Department of Neurology, Molde Hospital, Molde, Norway., Steffensen LH; Department of Neurology, University Hospital of North Norway, Tromsø, Norway., Sømark J; Department of Neurology, Innlandet Hospital Trust, Lillehammer Hospital, Lillehammer, Norway., Tobro H; Department of Neurology, Telemark Hospital, Skien, Norway., Truelsen TC; Department of Neurology, Rigshospitalet University Hospital, Copenhagen, Denmark., Wassvik L; Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark., Ægidius KL; Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark., Atar D; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.; Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway., Aamodt AH; Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway. a.h.aamodt@medisin.uio.no.; Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. a.h.aamodt@medisin.uio.no.
Jazyk: angličtina
Zdroj: Journal of neurology [J Neurol] 2023 Aug; Vol. 270 (8), pp. 4049-4059. Date of Electronic Publication: 2023 May 10.
DOI: 10.1007/s00415-023-11680-8
Abstrakt: 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, CHA 2 DS 2 -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.
(© 2023. The Author(s).)
Databáze: MEDLINE
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