J Pagola1, J Juega1, J Francisco-Pascual2,3, A Bustamante4, A Penalba4, E Pala4, M Rodriguez1, M De Lera Alfonso5, J F Arenillas5, J A Cabezas6, F Moniche6, R de Torres7, J Montaner7, T González-Alujas3,8, J Alvarez-Sabin1, C A Molina1. 1. Stroke Unit, Neurology Department and Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Barcelona, Spain. 2. Arrhythmia Unit Cardiology Department, Vall d'Hebrón Hospital, Barcelona, Spain. 3. CIBER-CV. Instituto de Salud Carlos III, Madrid, Spain. 4. Neurovascular Research Laboratory, Vall d'Hebrón Research Institute, Barcelona,, Spain. 5. Stroke Unit, University Hospital of Valladolid, Valladolid, Spain. 6. Stroke Unit, University Hospital Virgen del Rocio, Sevilla, Spain. 7. Stroke Unit, University Hospital Virgen Macarena, Sevilla, Spain. 8. Echocardiography Laboratory Cardiology Department, Vall d'Hebrón Hospital, Barcelona, Spain.
Abstract
BACKGROUND AND PURPOSE: Covert paroxysmal atrial fibrillation (pAF) is the most frequent cause of cardiac embolism. Our goal was to discover parameters associated with early pAF detection with intensive cardiac monitoring. METHOD: Crypto-AF was a multicentre prospective study (four Comprehensive Stroke Centres) to detect pAF in non-lacunar cryptogenic stroke continuously monitored within the first 28 days. Stroke severity, infarct pattern, large vessel occlusion (LVO) at baseline, electrocardiography analysis, supraventricular extrasystolia in the Holter examination, left atrial volume index and brain natriuretic peptide level were assessed. The percentage of pAF detection and pAF episodes lasting more than 5 h were registered. RESULTS: Out of 296 patients, 264 patients completed the monitoring period with 23.1% (61/264) of pAF detection. Patients with pAF were older [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.01-1.08], they had more haemorrhagic infarction (OR 4.03, 95% CI 1.44-11.22), they were more likely to have LVO (OR 4.29, 95% CI 2.31-7.97) (P < 0.0001), they had a larger left atrial volume index (OR 1.03, 95% CI 1.01-1.1) (P = 0.0002) and they had a higher level of brain natriuretic peptide (OR 1.01, 95% CI 1.0-1.1). Age and LVO were independently associated with pAF detection (OR 1.06, 95% CI 1.00-1.16, and OR 4.58, 95% CI 2.27- 21.38, respectively). Patients with LVO had higher cumulative incidence of pAF (log rank P < 0.001) and more percentage of pAF > 5 h [29.6% (21/71) vs. 8.3% (12/144); OR 4.62, 95% CI 2.11-10.08; P < 0.001]. In a mean follow-up of 26.82 months (SD 10.15) the stroke recurrence rate was 4.6% (12/260). CONCLUSIONS: Large vessel occlusion in cryptogenic stroke emerged as an independent marker of pAF.
BACKGROUND AND PURPOSE: Covert paroxysmal atrial fibrillation (pAF) is the most frequent cause of cardiac embolism. Our goal was to discover parameters associated with early pAF detection with intensive cardiac monitoring. METHOD: Crypto-AF was a multicentre prospective study (four Comprehensive Stroke Centres) to detect pAF in non-lacunar cryptogenic stroke continuously monitored within the first 28 days. Stroke severity, infarct pattern, large vessel occlusion (LVO) at baseline, electrocardiography analysis, supraventricular extrasystolia in the Holter examination, left atrial volume index and brain natriuretic peptide level were assessed. The percentage of pAF detection and pAF episodes lasting more than 5 h were registered. RESULTS: Out of 296 patients, 264 patients completed the monitoring period with 23.1% (61/264) of pAF detection. Patients with pAF were older [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.01-1.08], they had more haemorrhagic infarction (OR 4.03, 95% CI 1.44-11.22), they were more likely to have LVO (OR 4.29, 95% CI 2.31-7.97) (P < 0.0001), they had a larger left atrial volume index (OR 1.03, 95% CI 1.01-1.1) (P = 0.0002) and they had a higher level of brain natriuretic peptide (OR 1.01, 95% CI 1.0-1.1). Age and LVO were independently associated with pAF detection (OR 1.06, 95% CI 1.00-1.16, and OR 4.58, 95% CI 2.27- 21.38, respectively). Patients with LVO had higher cumulative incidence of pAF (log rank P < 0.001) and more percentage of pAF > 5 h [29.6% (21/71) vs. 8.3% (12/144); OR 4.62, 95% CI 2.11-10.08; P < 0.001]. In a mean follow-up of 26.82 months (SD 10.15) the stroke recurrence rate was 4.6% (12/260). CONCLUSIONS: Large vessel occlusion in cryptogenic stroke emerged as an independent marker of pAF.
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: Elena Palà; Alejandro Bustamante; Jorge Pagola; Jesus Juega; Jaume Francisco-Pascual; Anna Penalba; Maite Rodriguez; Mercedes De Lera Alfonso; Juan F Arenillas; Juan Antonio Cabezas; Soledad Pérez-Sánchez; Francisco Moniche; Reyes de Torres; Teresa González-Alujas; Josep Lluís Clúa-Espuny; Juan Ballesta-Ors; Domingo Ribas; Juan Acosta; Alonso Pedrote; Felipe Gonzalez-Loyola; Delicia Gentile Lorente; Miguel Ángel Muñoz; Carlos A Molina; Joan Montaner Journal: Front Cardiovasc Med Date: 2022-07-04
Authors: Elena Palà; Jorge Pagola; Jesus Juega; Jaume Francisco-Pascual; Anna Penalba; Maite Rodriguez; Mercedes De Lera Alfonso; Juan F Arenillas; Juan Antonio Cabezas; Francisco Moniche; Reyes de Torres; Soledad Perez-Sanchez; Teresa González-Alujas; Carlos A Molina; Alejandro Bustamante; Joan Montaner Journal: Int J Cardiol Heart Vasc Date: 2022-03-07
Authors: Charlotte Sabine Weyland; Panagiotis Papanagiotou; Niclas Schmitt; Olivier Joly; Pau Bellot; Yahia Mokli; Peter Arthur Ringleb; A Kastrup; Markus A Möhlenbruch; Martin Bendszus; Simon Nagel; Christian Herweh Journal: Front Neurol Date: 2022-04-05 Impact factor: 4.003