Abstract WP278: Underutilization of Outpatient Cardiac Monitoring in Patients With Embolic Stroke of Unknown Source

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Brittany A Ricci ◽  
Andrew D Chang ◽  
Morgan Hemendinger ◽  
Priya Narwal ◽  
Katarina Dakay ◽  
...  
Keyword(s):  
Embolic Stroke ◽  
Cardiac Monitoring ◽  
Unknown Source

A Simple Score That Predicts Paroxysmal Atrial Fibrillation on Outpatient Cardiac Monitoring after Embolic Stroke of Unknown Source

2018 ◽  
Vol 27 (6) ◽  
pp. 1692-1696 ◽  
Author(s):  
Brittany Ricci ◽  
Andrew D. Chang ◽  
Morgan Hemendinger ◽  
Katarina Dakay ◽  
Shawna Cutting ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Paroxysmal Atrial Fibrillation ◽  
Embolic Stroke ◽  
Cardiac Monitoring ◽  
Unknown Source

Abstract WMP61: Recurrent Stroke Rates in Short versus Long Term Cardiac Monitoring in Patients With Embolic Stroke of Unknown Source

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Brittany Ricci ◽  
Andrew Chang ◽  
Morgan Hemendinger ◽  
Priya Narwal ◽  
Katarina Dakay ◽  
...  
Keyword(s):  
Recurrent Stroke ◽  
Embolic Stroke ◽  
Cardiac Monitoring ◽  
Unknown Source

scholarly journals Remote Cardiac Rhythm Monitoring – Establishing Remote Cardiac Monitoring Criteria for Embolic Stroke Unknown Source (ESUS) Patients at Auckland City Hospital

2018 ◽  
Vol 27 ◽  
pp. S5
Author(s):  
Rebecca Mitchell ◽  
Shaheeda Ali ◽  
Sleshni Chand ◽  
Shinu Kurian ◽  
Esther Lee ◽  
...  
Keyword(s):  
Cardiac Rhythm ◽  
Embolic Stroke ◽  
Cardiac Monitoring ◽  
City Hospital ◽  
Unknown Source ◽  
Rhythm Monitoring

Abstract WP202: A Simple Score That Predicts Paroxysmal Atrial Fibrillation on Outpatient Cardiac Monitoring After Embolic Stroke of Unknown Source

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Brittany A Ricci ◽  
Andrew D Chang ◽  
Morgan Hemendinger ◽  
Katarina Dakay ◽  
Shawna M Cutting ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Paroxysmal Atrial Fibrillation ◽  
Embolic Stroke ◽  
Cardiac Monitoring ◽  
Unknown Source

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

Circulation ◽  
2021 ◽  
Author(s):  
Maria Cecilia Bahit ◽  
Ralph L. Sacco ◽  
J. Donald Easton ◽  
Juliane Meyerhoff ◽  
Lisa Cronin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Body Mass Index ◽  
Body Mass ◽  
Recurrent Stroke ◽  
Controlled Trial ◽  
Clinical Care ◽  
Important Variable ◽  
Older Age ◽  
Embolic Stroke ◽  
Cardiac Monitoring

Background: A proportion of patients with embolic stroke of undetermined source (ESUS) have silent atrial fibrillation (AF) or develop AF after the initial evaluation. Better understanding of risk for development of AF is critical to implement optimal monitoring strategies with the goal of preventing recurrent stroke due to underlying AF. The RE-SPECT ESUS trial provides an opportunity to assess predictors for developing AF and associated recurrent stroke. Methods: RE-SPECT ESUS was a randomized, controlled trial (564 sites, 42 countries) assessing dabigatran versus aspirin for the prevention of recurrent stroke in patients with ESUS. Of 5390 patients enrolled and followed for a median of 19 months, 403 (7.5%) were found to develop AF reported as an adverse event or using cardiac monitoring per standard clinical care. Univariable and multivariable regression analyses were performed to define predictors of AF. Results: In the multivariable model, older age (odds ratio [OR] for 10-year increase 1.99 [1.78-2.23]; P<0.001), hypertension (1.36 [1.03-1.79]; P=0.0304), diabetes (OR 0.74 [0.56-0.96]; P=0.022), and body mass index (OR for 5-unit increase 1.29 [1.16-1.43]; P<0.001) were independent predictors of AF during the study. In a sensitivity analysis restricted to 1117 patients with baseline N-terminal prohormone of brain natriuretic peptide (NT-proBNP) measurements, only older age and higher NT-proBNP were significant independent predictors of AF. Performances of several published predictive models were assessed, including the HAVOC and CHA2DS2-VASc scores, and higher scores were associated with higher rates of developing AF. Conclusions: Besides age as the most important variable, several other factors, including hypertension, higher body mass index, and lack of diabetes, are independent predictors of AF after ESUS. When baseline NT-proBNP was available, only older age and elevation of this biomarker were predictive of subsequent AF. Understanding who is at higher risk of developing AF will assist in identifying patients who may benefit from more intense, long-term cardiac monitoring.

Implications of Janus Kinase 2 Mutation in Embolic Stroke of Unknown Source

2018 ◽  
Vol 27 (10) ◽  
pp. 2572-2578 ◽  
Author(s):  
Gabriela Trifan ◽  
Neelofer Shafi ◽  
Fernando D. Testai
Keyword(s):  
Janus Kinase ◽  
Embolic Stroke ◽  
Janus Kinase 2 ◽  
Unknown Source

Abstract 80: Left Atrial Structural and Functional Parameters in Ischemic Stroke Patients Show Differences in Cardioembolic versus Embolic Strokes of Unknown Source (ESUS) and Other Determined Causes: Rethinking Whether ESUS Patients Should be Treated as Cardioembolic Equivalents

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Melanie Winningham ◽  
Srikant Rangaraju ◽  
Ghada A Mahmoud ◽  
Syed Ali Raza ◽  
Maggie Salinger ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Left Atrial ◽  
Anticoagulation Therapy ◽  
Cardiac Monitoring ◽  
Volume Index ◽  
Stroke Patients ◽  
Functional Parameters ◽  
Unknown Source ◽  
Baseline Characteristics ◽  
Stroke Center

Background: The role of anticoagulation in patients with embolic strokes of unknown source (ESUS) remains controversial. Left atrial (LA) structural and functional parameters on transthoracic echocardiography (TTE) may predict ESUS patients who are likely to develop subsequent paroxysmal atrial fibrillation (PAF). Hypothesis: LA parameters in ESUS patients will be similar to cardioembolic (CE) stroke patients and different from patients with strokes due to other determined cause (ODC). Methods: Patients admitted to a stroke center from June 1 to November 30, 2015 with acute ischemic stroke were included in this analysis. Baseline characteristics and results of inpatient diagnostic workup including neuroimaging, echocardiography, and cardiac telemetry were reviewed retrospectively to classify patients into three subtypes: CE, ODC or ESUS. LA diameter, LA volume index (LAVI), mitral valve early (MV E) and late filling peak (MV Peak A) velocities were compared between the 3 subtypes. Results: Of 131 patients (mean age 67 ± 16, 47% female, 45% white), 35 (27%) were classified as CE, 62 (47%) ODC and 34 (26%) ESUS. Baseline characteristics were similar between groups except that ODC patients were less likely to be female than CE and ESUS patients (p=0.05). LAVI, MV E and MV Peak A were all significantly different in CE compared with ODC and ESUS patients (p<0.05), with LA diameter showing a trend toward significance (p=0.058) (Figure). ESUS patients had LA diameter, LAVI, MV E and MV Peak A that were more similar to ODC than CE patients. Conclusions: LA structural and functional parameters among CE patients in our cohort were significantly different from those of ESUS and ODC patients, suggesting that ESUS patients may have lower risk of AF (and therefore lower likelihood of benefit from preemptive anticoagulation). Our study suggests that ESUS patients may benefit from long-term cardiac monitoring prior to initiation of anticoagulation therapy.

scholarly journals Embolic Stroke of Unknown Source Clinical Trials and Advances in Research

2020 ◽  
Vol 88 (3) ◽  
pp. 462-463
Author(s):  
Michelle C. Johansen ◽  
Romergryko G. Geocadin ◽  
Hooman Kamel
Keyword(s):  
Clinical Trials ◽  
Embolic Stroke ◽  
Unknown Source

The role of atrial fibrillation in patients with an embolic stroke of unknown source (ESUS)

2017 ◽  
Vol 117 (10) ◽  
pp. 1833-1835 ◽  
Author(s):  
Ben Freedman ◽  
Rolf Wachter
Keyword(s):  
Atrial Fibrillation ◽  
Embolic Stroke ◽  
Unknown Source

scholarly journals Apixaban for treatment of embolic stroke of undetermined source (ATTICUS) randomized trial – update of patient characteristics and study timeline after interim analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Poli ◽  
C Meissner ◽  
H J Baezner ◽  
A Kraft ◽  
F Hillenbrand ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Embolic Stroke ◽  
High Rate ◽  
Cardiac Monitoring ◽  
Severe Bleeding ◽  
Current Standard ◽  
Private Company ◽  
The Impact

Abstract Background Secondary prevention after embolic stroke of undetermined source (ESUS) has not yet been established. ESUS is associated with high risk of recurrent ischemic stroke and clinically silent ischemic lesions. Secondary prevention with aspirin is the current standard therapy in ESUS patients, despite high prevalence of occult atrial fibrillation (AF). Purpose To determine whether the direct oral factor Xa inhibitor apixaban, started within 28 days after index stroke, is superior to aspirin in preventing new ischemic lesions in subjects with remote cardiac monitoring. Primary endpoint was detection of new ischemic lesions in flair and diffusion-weighted (DWI) MR imaging at 12 months follow-up. Methods The study enrolled ESUS patients with risk profile for cardiac thromboembolism (i.e., left atrium (LA) size &gt;45 mm, spontaneous echo contrast in LA appendage, LA appendage flow velocity ≤0.2 cm/s, atrial high rate episodes, CHA2DS2-Vasc score ≥4, patent foramen ovale). Patients were randomized 1:1 into the aspirin and apixaban arms. Study drug was initiated within 3–28 days after minor/moderate stroke and 14–28 days after major stroke. MRI (Flair/DWI) was conducted within 7 days of AF detection by remote cardiac monitors and at 12 months. ClinicalTrials.gov Identifier: NCT02427126. Funding: The trial is supported by BMS-Pfizer Alliance. Results Enrollment was stopped after interims analysis (including 200 patients) due to futility. Overall, 373 patients were screened with 353 being enrolled (178 and 175 in apixaban and ASA arms, respectively). So far, 130 (73.0%) and 120 (68.6%) subjects from apixaban and ASA arms, respectively, completed the study. 2% death, 1.7% withdrawal, and 1.7% were lost to follow-up. 3.9% did not completed the study for other reasons. Mean age of the ATTICUS population was 68.5 years with 51% males. 80% of the subjects suffered from hypertension. Mean systolic blood pressure at enrollment was 132 mmHg, BMI was 27.7, and CHA2DS-VASc-Score was 4.9. So far, adverse events (AE) occurred in 63% of the subjects, 30% was documented as severe. 6.8% cases of recurrent ischemic stroke and no case of hemorrhagic stroke were reported. Only 1 case of severe bleeding was reported in the aspirin arm. Newly detected AF was reported in 80 patients (23%), 42 occurring in the aspirin arm. As required by protocol, latter were immediately switched from aspirin to apixaban. Due to ongoing data clearing, numbers and % will change until presentation. Conclusions In contrast to the recently published NAVIGATE and RESPECT ESUS trials, patients enrolled in ATTICUS need to exhibit additional AF predicting factors. Furthermore, mandatory cardiac remote monitoring will help to elucidate the impact of AF and the effects of early oral anticoagulation with apixaban compared to antiplatelet therapy with aspirin on the incidence of new ischemic lesions after ESUS. Preliminary data will be presented and discussed in the context of current literature. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): The trial is supported by BMS-Pfizer Alliance.

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