Prediction of underlying atrial fibrillation in patients with a cryptogenic stroke: results from the NOR-FIB Study

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  • B. Ratajczak-Tretel
  • A. Tancin Lambert
  • R. Al-Ani
  • K. Arntzen
  • G. K. Bakkejord
  • H. M. O. Bekkeseth
  • V. Bjerkeli
  • G. Eldøen
  • A. K. Gulsvik
  • B. Halvorsen
  • G. A. Høie
  • H. Ihle-Hansen
  • H. Ihle-Hansen
  • S. Ingebrigtsen
  • C. Kremer
  • S. B. Krogseth
  • Kruuse, Christina Rostrup
  • M. Kurz
  • I. Nakstad
  • V. Novotny
  • H. Næss
  • R. Qazi
  • M. K. Rezaj
  • D. M. Rørholt
  • L. H. Steffensen
  • J. Sømark
  • H. Tobro
  • Truelsen, Thomas Clement
  • L. Wassvik
  • K. L. Ægidius
  • D. Atar
  • Anne Hege Aamodt
  • NOR-FIB study group

Background: Atrial fibrillation (AF) detection and treatment are key elements to reduce recurrence risk in cryptogenic stroke (CS) with underlying arrhythmia. The purpose of the present study was to assess the predictors of AF in CS and the utility of existing AF-predicting scores in The Nordic Atrial Fibrillation and Stroke (NOR-FIB) Study. Method: The NOR-FIB study was an international prospective observational multicenter study designed to detect and quantify AF in CS and cryptogenic transient ischaemic attack (TIA) patients monitored by the insertable cardiac monitor (ICM), and to identify AF-predicting biomarkers. The utility of the following AF-predicting scores was tested: AS5F, Brown ESUS-AF, CHA2DS2-VASc, CHASE-LESS, HATCH, HAVOC, STAF and SURF. Results: In univariate analyses increasing age, hypertension, left ventricle hypertrophy, dyslipidaemia, antiarrhythmic drugs usage, valvular heart disease, and neuroimaging findings of stroke due to intracranial vessel occlusions and previous ischemic lesions were associated with a higher likelihood of detected AF. In multivariate analysis, age was the only independent predictor of AF. All the AF-predicting scores showed significantly higher score levels for AF than non-AF patients. The STAF and the SURF scores provided the highest sensitivity and negative predictive values, while the AS5F and SURF reached an area under the receiver operating curve (AUC) > 0.7. Conclusion: Clinical risk scores may guide a personalized evaluation approach in CS patients. Increasing awareness of the usage of available AF-predicting scores may optimize the arrhythmia detection pathway in stroke units.

OriginalsprogEngelsk
TidsskriftJournal of Neurology
Vol/bind270
Udgave nummer8
Sider (fra-til)4049-4059
Antal sider11
ISSN0340-5354
DOI
StatusUdgivet - 2023

Bibliografisk note

Funding Information:
Open access funding provided by University of Oslo (incl Oslo University Hospital). NOR-FIB is an investigator-driven academic study, supported by Oslo University Hospital, Norwegian Health Association, South-Eastern Norway Regional Health Authority (BRT and ATL PhD fellowship) and Østfold Hospital Trust. Devices were partly provided by Medtronic.

Publisher Copyright:
© 2023, The Author(s).

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