scholarly journals Association of the CHA2D(S2)-VASc Score and Its Components With Overt and Silent Ischemic Brain Lesions in Patients With Atrial Fibrillation

2021 ◽  
Vol 11 ◽  
Author(s):  
Fabienne Steiner ◽  
Pascal B. Meyre ◽  
Stefanie Aeschbacher ◽  
Michael Coslovsky ◽  
Tim Sinnecker ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Transient Ischemic Attack ◽  
Brain Lesion ◽  
Brain Lesions ◽  
Multicenter Cohort Study ◽  
Clinical Trial Registration ◽  
Cross Sectional ◽  
Ischemic Brain ◽  
History Of ◽  
Ischemic Attack

Background: Silent and overt ischemic brain lesions are common and associated with adverse outcome. Whether the CHA2DS2-VASc score and its components predict magnetic resonance imaging (MRI)-detected ischemic silent and overt brain lesions in patients with atrial fibrillation (AF) is unclear.Methods: In this cross-sectional analysis, patients with AF were enrolled in a multicenter cohort study in Switzerland. Outcomes were clinically overt, silent [in the absence of a history of stroke/transient ischemic attack (TIA)] and any MRI-detected ischemic brain lesions. Logistic regression analyses were performed to assess the relationship of the CHA2DS2-VASc score and its components with ischemic brain lesions. An adapted CHA2D-VASc score (excluding history of stroke/TIA) for the analyses of clinically overt and silent ischemic brain lesions was used.Results: Overall, 1,741 patients were included in the analysis (age 73 ± 8 years, 27.4% female). At least one ischemic brain lesion was observed in 36.8% (clinically overt: 10.5%; silent: 22.9%; transient ischemic attack: 3.4%). The CHA2D-VASc score was strongly associated with clinically overt and silent ischemic brain lesions {odds ratio (OR) [95% confidence interval (CI)] 1.32 (1.17–1.49), p < 0.001 and 1.20 (1.10–1.30), p < 0.001, respectively}. Age 65–74 years (OR 2.58; 95%CI 1.29–5.90; p = 0.013), age ≥75 years (4.13; 2.07–9.43; p < 0.001), hypertension (1.90; 1.28–2.88; p = 0.002) and diabetes (1.48; 1.00–2.18; p = 0.047) were associated with clinically overt brain lesions, whereas age 65–74 years (1.95; 1.26–3.10; p = 0.004), age ≥75 years (3.06; 1.98–4.89; p < 0.001) and vascular disease (1.39; 1.07–1.79; p = 0.012) were associated with silent ischemic brain lesions.Conclusions: A higher CHA2D-VASc score was associated with a higher risk of both overt and silent ischemic brain lesions.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT02105844.

Impaired heart rate variability triangular index to identify clinically silent strokes in patients with atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Haemmerle ◽  
C Eick ◽  
A Bauer ◽  
K.D Rizas ◽  
M Coslovsky ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Transient Ischemic Attack ◽  
Brain Mri ◽  
Binary Logistic Regression ◽  
Funding Source ◽  
Logistic Regression Models ◽  
History Of ◽  
Ischemic Attack

Abstract Introduction The identification of clinically silent strokes in patients with atrial fibrillation (AF) is of high clinical relevance as they have been linked to cognitive impairment. Overt strokes have been associated with disturbances of the autonomic nervous system. Purpose We therefore hypothesize that impaired heart rate variability (HRV) can identify AF patients with clinically silent strokes. Methods We enrolled 1358 patients with AF without a history of stroke or transient ischemic attack from the multicenter SWISS-AF cohort study who were in sinus rhythm (SR-group, n=816) or AF (AF-group, n=542) on a 5 minute resting ECG recording. HRV triangular index (HRVI), the standard deviation of normal-to-normal intervals (SDNN) and the mean heart rate (MHR) were calculated. Brain MRI was performed at baseline to assess the presence of large non-cortical or cortical infarcts, which were considered silent strokes without history of stroke or transient ischemic attack. We constructed binary logistic regression models to analyze the association between HRV parameters and silent strokes. Results At baseline, silent strokes were detected in 10.5% in the SR group and 19.9% in the AF group. In the SR-group, HRVI <15 was the only parameter independently associated with the presence of silent strokes (odds ratio (OR) 1.69; 95% confidence interval (CI): 1.04–2.72; p=0.033) after adjustment for various clinical covariates (age, sex, systolic blood pressure, history of hypertension, history of diabetes, history of heart failure, prior myocardial infarction, prior major bleeding, intake of oral anticoagulation, antiarrhythmics or betablockers). Similarly, in the AF-group, HRVI<15 was independently associated with the presence of silent strokes (OR 1.65, 95% CI: 1.05–2.57; p=0.028). SDNN<70ms and MHR<80 were not associated with silent strokes, neither in the SR group, nor in the AF group (Figure). Conclusions Reduced HRVI is independently associated with the presence of clinically silent strokes in an AF population, both when assessed during SR and during AF. Our data suggest that a short-term measurement of HRV in routine ECG recordings might contribute to identifying AF patients with clinically silent strokes. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Swiss National Science Foundation

scholarly journals B Vitamins and Magnetic Resonance Imaging–Detected Ischemic Brain Lesions in Patients With Recent Transient Ischemic Attack or Stroke

Stroke ◽  
2012 ◽  
Vol 43 (12) ◽  
pp. 3266-3270 ◽  
Author(s):  
Margherita Cavalieri ◽  
Reinhold Schmidt ◽  
Christopher Chen ◽  
Vincent Mok ◽  
Gabriel R. de Freitas ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Transient Ischemic Attack ◽  
Brain Lesions ◽  
B Vitamins ◽  
Resonance Imaging ◽  
Ischemic Brain ◽  
Ischemic Attack

scholarly journals Atrial Fibrillation and Stroke Symptoms in the REGARDS Study

2022 ◽  
Author(s):  
Meghan Reading Turchioe ◽  
Elsayed Z. Soliman ◽  
Parag Goyal ◽  
Alexander E. Merkler ◽  
Hooman Kamel ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Racial Differences ◽  
Transient Ischemic Attack ◽  
Antiplatelet Agent ◽  
Antiplatelet Agents ◽  
Clinical History ◽  
Cross Sectional ◽  
Symptom Screening ◽  
Stroke Diagnosis ◽  
Ischemic Attack

Background It is unknown if stroke symptoms in the absence of a stroke diagnosis are a sign of subtle cardioembolic phenomena. The objective of this study was to examine associations between atrial fibrillation (AF) and stroke symptoms among adults with no clinical history of stroke or transient ischemic attack (TIA). Methods and Results We evaluated associations between AF and self‐reported stroke symptoms in the national, prospective REGARDS (Reasons for Geographic and Racial Differences in Stroke) cohort. We conducted cross‐sectional (n=27 135) and longitudinal (n=21 932) analyses over 8 years of follow‐up of REGARDS participants without stroke/transient ischemic attack and stratified by anticoagulant or antiplatelet agent use. The mean age was 64.4 (SD±9.4) years, 55.3% were women, and 40.8% were Black participants; 28.6% of participants with AF reported stroke symptoms. In the cross‐sectional analysis, comparing participants with and without AF, the risk of stroke symptoms was elevated for adults with AF taking neither anticoagulants nor antiplatelet agents (odds ratio [OR], 2.22; 95% CI, 1.89–2.59) or antiplatelet agents only (OR, 1.92; 95% CI, 1.61–2.29) but not for adults with AF taking anticoagulants (OR, 1.08; 95% CI, 0.71–1.65). In the longitudinal analysis, the risk of stroke symptoms was also elevated for adults with AF taking neither anticoagulants nor antiplatelet agents (hazard ratio [HR], 1.41; 95% CI, 1.21–1.66) or antiplatelet agents only (HR, 1.23; 95% CI, 1.04–1.46) but not for adults with AF taking anticoagulants (HR, 0.86; 95% CI, 0.62–1.18). Conclusions Stroke symptoms in the absence of a stroke diagnosis may represent subclinical cardioembolic phenomena or “whispering strokes.” Future studies examining the benefit of stroke symptom screening may be warranted.

scholarly journals Prior stroke and transient ischemic attack as risk factors for subsequent stroke in atrial fibrillation patients: A report from the GARFIELD-AF registry

2019 ◽  
Vol 15 (3) ◽  
pp. 308-317
Author(s):  
Werner Hacke ◽  
Jean-Pierre Bassand ◽  
Saverio Virdone ◽  
A John Camm ◽  
David A Fitzmaurice ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Transient Ischemic Attack ◽  
Cardiovascular Death ◽  
Cerebrovascular Event ◽  
Systemic Embolism ◽  
Risk Of Death ◽  
All Cause Mortality ◽  
History Of ◽  
Ischemic Attack ◽  
Prior Stroke

Background It is not always possible to verify whether a patient complaining of symptoms consistent with transient ischemic attack has had an actual cerebrovascular event. Research question To characterize the risk of cardiovascular events associated with a history of stroke/transient ischemic attack in patients with atrial fibrillation. Study design and methods This study investigated the clinical characteristics and outcomes of patients with a history of stroke/transient ischemic attack among 52,014 patients enrolled prospectively in GARFIELD-AF registry. The diagnosis of stroke or transient ischemic attack was not protocol defined but based on physicians’ assessment. Patients’ one-year risk of death, stroke/systemic embolism, and major bleeding was assessed by multivariable Cox regression. Results At enrollment, 5617 (10.9%) patients were reported to have a history of stroke or transient ischemic attack. Patients with stroke or transient ischemic attack were older and had a greater burden of diabetes, moderate-to-severe kidney disease, and atherothrombosis and higher median CHA2DS2-VASc and HAS-BLED scores than those without history of stroke or transient ischemic attack. After adjustment, prior stroke/transient ischemic attack was associated with significantly higher risk for all-cause mortality (hazard ratio (HR), 1.26; 95% confidence interval (CI), 1.12–1.42), cardiovascular death (HR, 1.22; 95% CI, 1.01–1.48), non-cardiovascular death (HR, 1.39; 95% CI, 1.15–1.68), and stroke/systemic embolism (HR, 2.17; 95% CI, 1.80–2.63) than patients without history of stroke/transient ischemic attack. In patients with a prior stroke alone higher risk was observed for all-cause mortality (HR, 1.29; 95% CI, 1.11–1.50), non-cardiovascular death (HR, 1.39; 95% CI, 1.10–1.77), and stroke/systemic embolism (HR, 2.29; 95% CI, 1.83–2.86). No significantly elevated risk of adverse events was seen for patients with history of transient ischemic attack alone. Interpretation A history of prior stroke or transient ischemic attack is a strong independent risk factor for mortality and stroke/systemic embolism. This excess risk is mainly attributed to a history of stroke (with or without transient ischemic attack), whereas history of transient ischemic attack is a weaker predictor. Clinical trial registration: NCT01090362.

Abstract TP418: Delayed Detection Of Atrial Fibrillation After Ischemic Stroke Or Transient Ischemic Attack

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Maria C Zurru ◽  
LAURA BRESCACIN ◽  
Claudia Alonzo ◽  
Victor Villarroel ◽  
Gabriela Orzuza ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Recurrence Risk ◽  
Improvement Program ◽  
Profile Control ◽  
History Of ◽  
Ischemic Attack

Background and purpose: detection of atrial fibrillation (AF) after ischemic stroke is crucial, because anticoagulation is mandatory in order to decrease recurrence risk. However, there is no agreement regarding the optimal method to detect paroxysmal AF after the event. The aim of this study was to evaluate predictors for delayed detection of AF after ischemic stroke (IS) and transient ischemic attack (TIA). Methods: PROTEGE-ACV is a multidisciplinary stroke quality improvement program coordinated by internists and neurologists within a Buenos Aires healthcare system aimed to optimize secondary stroke preventive care after IS or TIA. Demographic data, vascular risk factors profile control and management were evaluated at the inclusion visit, and IS was categorized according to TOAST classification. Results: From 01/2007 to 04 /2012, 872 ischemic stroke patients were included; mean age was 75 ± 10 years-old and 55% were female. Twenty two percent were cardioembolic and 7% undetermined with more than one mechanism with AF as one of them; 14% of patients had history of AF or diagnosis at hospitalization. Incident AF was diagnosed in 101 (21%) of 473 patients with two or more years of follow-up.. Diagnosis of AF was associated with age older than 80 years (OR 1.96 95% CI 1.25-3), history of hypertension (OR 2.4 95% CI 1.25-4.8), chronic renal failure (OR 2.65 95% CI 1.54-4.55) and stroke recurrence (OR 2.96 95% CI 1.66-5.26). Conclusion: delayed diagnosis of AF was common in this cohort of patients with IS or TIA. Identification of risk factors is important in order to perform a close follow-up of these patients and to determine the best method for this purpose, in order to reduce recurrence risk.

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