Brittany Ricci1, Andrew D Chang1, Morgan Hemendinger1, Katarina Dakay1, Shawna Cutting1, Tina Burton1, Brian Mac Grory1, Priya Narwal1, Christopher Song2, Antony Chu2, Emile Mehanna2, Ryan McTaggart3, Mahesh Jayaraman4, Karen Furie1, Shadi Yaghi5. 1. Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island. 2. Department of Internal Medicine, Division of Cardiovascular Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island. 3. Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island; Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, Rhode Island. 4. Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island; Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island; Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, Rhode Island. 5. Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island. Electronic address: shadiyaghi@yahoo.com.
Abstract
BACKGROUND: Occult paroxysmal atrial fibrillation (AF) is detected in 16%-30% of patients with embolic stroke of unknown source (ESUS). The identification of AF predictors on outpatient cardiac monitoring can help guide clinicians decide on a duration or method of cardiac monitoring after ESUS. METHODS: We included all patients with ESUS who underwent an inpatient diagnostic evaluation and outpatient cardiac monitoring between January 1, 2013, and December 31, 2016. Patients were divided into 2 groups based on detection of AF or atrial flutter during monitoring. We compared demographic data, clinical risk factors, and cardiac biomarkers between the 2 groups. Multivariable logistic regression was used to determine predictors of AF. RESULTS: We identified 296 consecutive patients during the study period; 38 (12.8%) patients had AF detected on outpatient cardiac monitoring. In a multivariable regression analysis, advanced age (ages 65-74: odds ratio [OR] 2.36, 95% confidence interval [CI] .85-6.52; ages 75 or older: OR 4.08, 95% CI 1.58-10.52) and moderate-to-severe left atrial enlargement (OR 4.66, 95% CI 1.79-12.12) were predictors of AF on outpatient monitoring. We developed the Brown ESUS-AF score: age (65-74 years: 1 point, 75 years or older: 2 points) and left atrial enlargement (moderate or severe: 2 points) with good prediction of AF (area under the curve .725) and was internally validated using bootstrapping. The percentage of patients with AF detected in each score category were as follows: 0: 4.2%; 1: 14.8%; 2: 20.8%; 3: 22.2%; 4: 55.6%. CONCLUSIONS: The Brown ESUS-AF score predicts AF on prolonged outpatient monitoring after ESUS. More studies are needed to externally validate our findings.
BACKGROUND: Occult paroxysmal atrial fibrillation (AF) is detected in 16%-30% of patients with embolic stroke of unknown source (ESUS). The identification of AF predictors on outpatient cardiac monitoring can help guide clinicians decide on a duration or method of cardiac monitoring after ESUS. METHODS: We included all patients with ESUS who underwent an inpatient diagnostic evaluation and outpatient cardiac monitoring between January 1, 2013, and December 31, 2016. Patients were divided into 2 groups based on detection of AF or atrial flutter during monitoring. We compared demographic data, clinical risk factors, and cardiac biomarkers between the 2 groups. Multivariable logistic regression was used to determine predictors of AF. RESULTS: We identified 296 consecutive patients during the study period; 38 (12.8%) patients had AF detected on outpatient cardiac monitoring. In a multivariable regression analysis, advanced age (ages 65-74: odds ratio [OR] 2.36, 95% confidence interval [CI] .85-6.52; ages 75 or older: OR 4.08, 95% CI 1.58-10.52) and moderate-to-severe left atrial enlargement (OR 4.66, 95% CI 1.79-12.12) were predictors of AF on outpatient monitoring. We developed the Brown ESUS-AF score: age (65-74 years: 1 point, 75 years or older: 2 points) and left atrial enlargement (moderate or severe: 2 points) with good prediction of AF (area under the curve .725) and was internally validated using bootstrapping. The percentage of patients with AF detected in each score category were as follows: 0: 4.2%; 1: 14.8%; 2: 20.8%; 3: 22.2%; 4: 55.6%. CONCLUSIONS: The Brown ESUS-AF score predicts AF on prolonged outpatient monitoring after ESUS. More studies are needed to externally validate our findings.
Authors: Marta Rubiera; Ana Aires; Kateryna Antonenko; Sabrina Lémeret; Christian H Nolte; Jukka Putaala; Renate B Schnabel; Anil M Tuladhar; David J Werring; Dena Zeraatkar; Maurizio Paciaroni Journal: Eur Stroke J Date: 2022-06-03
Authors: Susan X Zhao; Paul D Ziegler; Michael H Crawford; Calvin Kwong; Jodi L Koehler; Rod S Passman Journal: Ther Adv Neurol Disord Date: 2019-04-11 Impact factor: 6.570