scholarly journals Detection of Subclinical Paroxysmal Atrial Fibrillation and Its Correlation with Candidate Genes in Patients with Cryptogenic Ischemic Stroke and TIA

2021 ◽  
Vol 21 (2) ◽  
pp. 42-53
Author(s):  
A Petrovicova ◽  
E Kurca ◽  
A Andrasova ◽  
J Bernatova ◽  
P Blasko ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Paroxysmal Atrial Fibrillation ◽  
Cryptogenic Stroke ◽  
Preventive Treatment ◽  
Correct Choice ◽  
Control Group ◽  
Nucleotide Polymorphisms ◽  
Loop Recorder ◽  
Ischemic Attack

Abstract Introduction: Cardioembolic etiology is assumed to be the most frequent cause of cryptogenic strokes. The detection of subclinical paroxysmal atrial fibrillation (AF) is important in the correct choice of preventive treatment. The aim of this prospective study was to detect the incidence of AF in patients with a cryptogenic stroke or transient ischemic attack (TIA) and to evaluate the association between the presence of AF and selected single-nucleotide polymorphisms (SNP). Methods: Patients with a cryptogenic stroke/ TIA (n=100) and a control group (n=15) of volunteers without significant cardiovascular disease were included in the study during the period of 2014 to 2019. To detect AF they underwent 12 months of ECG monitoring using an implanted loop recorder (ILR). Genotyping for SNPs rs10033464, rs2200733, rs225132, and rs2106261 was performed by a high resolution melting analysis. Results: We found AF to be present in 24 (24%) patients with a cryptogenic stroke/TIA, versus no subjects in the control group. The SNPs rs2106261, rs2200733, rs225132, and rs10033464 were not found to be associated with AF in our study (p=0.240; 1.000; 0.887; 0.589). However, a weak trend for a higher frequency of rs2106261 risk allele A homozygotes was observed in the patients with AF compared to the patients without AF (0.416 vs. 0.263, p=0.073). Homozygotes for allele A of rs2106261 were also present in a significantly higher frequency in AF patients compared to the controls (0.416 vs. 0.133, p = 0.012). Conclusion: In our study paroxysmal AF was a probable etiological factor in 24% of patients with cryptogenic ischemic stroke / TIA during the 12 months of monitoring. The homozygous allele A of rs2106261 was identified to be the possible genetic risk factor of AF, but this should be verified in larger cohorts. The study has been registered at www.clinicaltrials.gov, identifier NCT02216370.

Usefulness of the ACTEL Score to Predict Atrial Fibrillation in Patients with Cryptogenic Stroke

Cardiology ◽  
2020 ◽  
Vol 145 (3) ◽  
pp. 168-177 ◽  
Author(s):  
Antonio Muscari ◽  
Pietro Barone ◽  
Luca Faccioli ◽  
Marco Ghinelli ◽  
Marco Pastore Trossello ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Characteristic Curve ◽  
Cryptogenic Stroke ◽  
Left Ventricular ◽  
Control Group ◽  
End Diastolic Volume ◽  
Electrocardiogram Monitoring

Introduction: To assess the probability of undetected atrial fibrillation (AF) in patients with ischemic stroke, we previously compared patients who were first diagnosed with AF with patients with large or small artery disease and obtained the MrWALLETS 8-item scoring system. In the present study, we utilized cryptogenic strokes (CS) as the control group, as AF is normally sought among CS patients. Methods: We retrospectively examined 191 ischemic stroke patients (72.5 ± 12.6 years), 68 with first diagnosed AF and 123 with CS, who had undergone 2 brain CT scans, echocardiography, carotid/vertebral ultrasound, continuous electrocardiogram monitoring and anamnestic/laboratory search for cardiovascular risk factors. Results: In logistic regression, 5 variables were independently associated with AF, forming the “ACTEL” score: Age ≥75 years (OR 2.42, 95% CI 1.18–4.96, p = 0.02; +1 point); hyperCholesterolemia (OR 0.38, 95% CI 0.18–0.78, p = 0.009; –1 point); Tricuspid regurgitation ≥ mild-to-moderate (OR 4.99, 95% CI 1.63–15.27, p = 0.005; +1 point); left ventricular End-diastolic volume <65 mL (OR 7.43, 95% CI 2.44–22.6, p = 0.0004; +1 point); Left atrium ≥4 cm (OR 4.57, 95% CI 1.97–10.62, p = 0.0004; +1 point). The algebraic sum of these points may range from –1 to +4. For AF identification, the area under the receiver operating characteristic curve was 0.80 (95% CI 0.73–0.87). With a cutoff of ≥2, positive predictive value was 80.8%, specificity 92.7% and sensitivity 55.9%. Conclusions: The ACTEL score, a simplified and improved version of the MrWALLETS score, allows the identification of patients with first diagnosed AF, in the context of CSs, with a high positive predictive value.

scholarly journals Predictors of Finding Occult Atrial Fibrillation After Cryptogenic Stroke

Stroke ◽  
2015 ◽  
Vol 46 (5) ◽  
pp. 1210-1215 ◽  
Author(s):  
Christopher G. Favilla ◽  
Erin Ingala ◽  
Jenny Jara ◽  
Emily Fessler ◽  
Brett Cucchiara ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Cryptogenic Stroke ◽  
Cardiac Monitoring ◽  
Cerebellar Infarction ◽  
Acute Infarction ◽  
Ischemic Attack ◽  
Low Prevalence

Background and Purpose— Occult paroxysmal atrial fibrillation (AF) is found in a substantial minority of patients with cryptogenic stroke. Identifying reliable predictors of paroxysmal AF after cryptogenic stroke would allow clinicians to more effectively use outpatient cardiac monitoring and ultimately reduce secondary stroke burden. Methods— We analyzed a retrospective cohort of consecutive patients who underwent 28-day mobile cardiac outpatient telemetry after cryptogenic stroke or transient ischemic stroke. Univariate and multivariable analyses were performed to identify clinical, echocardiographic, and radiographic features associated with the detection of paroxysmal AF. Results— Of 227 patients with cryptogenic stroke (179) or transient ischemic stroke (48), 14% (95% confidence interval, 9%–18%) had AF detected on mobile cardiac outpatient telemetry, 58% of which was ≥30 seconds in duration. Age >60 years (odds ratio, 3.7; 95% confidence interval, 1.3–11) and prior cortical or cerebellar infarction seen on neuroimaging (odds ratio, 3.0; 95% confidence interval, 1.2–7.6) were independent predictors of AF. AF was detected in 33% of patients with both factors, but only 4% of patients with neither. No other clinical features (including demographics, CHA 2 DS 2 -VASc [combined stroke risk score: congestive heart failure, hypertension, age, diabetes, prior stroke/transient ischemic attack, vascular disease, sex] score, or stroke symptoms), echocardiographic findings (including left atrial size or ejection fraction), or radiographic characteristics of the acute infarction (including location, topology, or number) were associated with AF detection. Conclusions— Mobile cardiac outpatient telemetry detects AF in a substantial proportion of cryptogenic stroke patients. Age >60 years and radiographic evidence of prior cortical or cerebellar infarction are robust indicators of occult AF. Patients with neither had a low prevalence of AF.

scholarly journals Diagnosis, prognosis, and management of cryptogenic stroke

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 168 ◽  
Author(s):  
Cen Zhang ◽  
Scott Kasner
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Trials ◽  
Ischemic Stroke ◽  
Diagnostic Criteria ◽  
Paroxysmal Atrial Fibrillation ◽  
Cryptogenic Stroke ◽  
Outcome Studies ◽  
Long Term Outcomes ◽  
Therapeutic Challenge

Despite many advances in our understanding of ischemic stroke, cryptogenic strokes (those that do not have a determined etiology) remain a diagnostic and therapeutic challenge. Previous classification approaches to cryptogenic stroke have led to inconsistent definitions, and evidence to determine optimal treatment is scarce. These limitations have prompted international efforts to redefine cryptogenic strokes, leading to more rigorous diagnostic criteria, outcome studies, and new clinical trials. Improvement in our ability to detect paroxysmal atrial fibrillation in patients with cryptogenic stroke has strengthened the idea that these strokes are embolic in nature. Further, better understanding of acute biomarkers has helped to identify otherwise occult mechanisms. Together, these strategies will inform long-term outcomes and shape management.

scholarly journals Presence of Atrial Fibrillation in Stroke Patients With Patent Foramen Ovale: Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Jessie Ze-Jun Chen ◽  
Vincent N. Thijs
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Confidence Interval ◽  
Lower Risk ◽  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Foramen Ovale ◽  
Stroke Patients ◽  
Loop Recorder ◽  
Cross Sectional

Purpose: Patent foramen ovale (PFO) is associated with ischemic stroke, especially in patients with embolic stroke of undetermined source. This study aims to evaluate the presence of atrial fibrillation (AF) in ischemic stroke patients with PFO.Methods: We systematically searched EMBASE and MEDLINE databases on May 21, 2020 for studies that analyzed the presence of AF in patients with PFO. The primary outcome was the presence of AF in patients with PFO compared with those without. Outcomes were pooled using a random-effects model using the method of DerSimonian and Laird. We recorded demographic characteristics and the methods used for AF detection in the studies included (unspecified, history/medical records review, ECG, Holter monitor, or loop recorder).Results: A total of 14 studies and 13,245 patients fulfilled the entry criteria. The average age was 61.2 years and 41.3% of the participants were female. There was a lower risk of AF in patients with PFO compared with those without (RR 0.52, 95% confidence interval, 0.41–0.63, p &lt; 0.001). There was no evidence of heterogeneity. The lower risk of AF was found in cross-sectional and longitudinal studies and in studies stratified by average age (&lt;60 or ≥60) and in cryptogenic stroke. Meta-regression by PFO detection technique suggested that studies using transoesophageal echocardiogram for PFO detection reported higher risk of AF (1.39, 95% confidence interval 1.14–1.70, p = 0.004).Conclusion: The presence of a PFO in patients with ischemic stroke/TIA may be associated with a lower risk of AF. Few studies have estimated the risk of future AF in patients with PFO.

scholarly journals 319 Appropriate Duration of Extended Cardiac Monitoring for Atrial Fibrillation in Cryptogenic Stroke

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Kate Donlon ◽  
Robert Murphy ◽  
Edel Mannion ◽  
Ruairi Waters
Keyword(s):  
Atrial Fibrillation ◽  
High Risk ◽  
Ischaemic Stroke ◽  
Paroxysmal Atrial Fibrillation ◽  
Cryptogenic Stroke ◽  
Cardiac Monitoring ◽  
Loop Recorder ◽  
External Loop ◽  
The Mean ◽  
Time To Detection

Abstract Background Strokes due to cardio embolism are generally more severe and prone to early and long term recurrence. All forms of anticoagulant therapy are associated with a two thirds risk reduction in acute ischaemic stroke associated with atrial fibrillation. Establishing a diagnosis of paroxysmal atrial fibrillation can be a challenging one. Our study will attempt to answer the question as to what duration of extended cardiac monitoring is required when screening for atrial fibrillation in cryptogenic stroke. Methods We examined the time of atrial fibrillation initial diagnosis in 50 patients with an original working diagnosis of cryptogenic stroke but later have atrial fibrillation confirmed on extended monitoring. All patients wore the external loop recorder from 1 day to 3 weeks’ duration. On return of the device, data from the external loop recorder was downloaded, and reviewed by a consultant cardiologist. The total duration of monitoring using the external loop recorder was recorded. The time to first episode of algorithm detected atrial fibrillation was recorded. Results The mean duration of extended cardiac monitoring using the external loop recorder was 120.1days By seven days, atrial fibrillation had been detected in 94% of patients. By 72 hours, atrial fibrillation had been detected in 78% of patients. The mean age of participants was 58.3 years. 54.4% were female. The mean time to detection of atrial fibrillation was 52.9 hours. The median time to detection of atrial fibrillation was 34.2 hours. Conclusion External loop recorders present an opportunity for detection of paroxysmal atrial fibrillation in high risk individuals. Our study shows the feasibility and accuracy of a screening duration of seven days in the high risk post ischaemic stroke population. A one week screening timeframe allows us to screen twice as many patients for paroxysmal atrial fibrillation. Successful screening for atrial fibrillation in this high risk group allows the commencement of acceptable and safe anticoagulant therapy.

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