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Eur J Neurol. 2013 Oct;20(10):1352-9. doi: 10.1111/ene.12017. Epub 2012 Nov 4.

Predictors of newly diagnosed atrial fibrillation in cryptogenic stroke: a cohort study.

Author information

1
Department of Neurology, Amiens University Hospital, Amiens, France; Laboratory of Functional Neurosciences and Pathology (EA 4559), Amiens, France; INSERM U1088, Amiens, France.

Abstract

BACKGROUND AND PURPOSE:

A significant proportion of cryptogenic ischaemic strokes are due to paroxysmal atrial fibrillation (AF). As paroxysmal AF appears to inexorably progress to persistent or permanent AF, this study with long-term follow-up was designed to establish the profile of patients who developed AF after hospital discharge.

METHODS:

All patients with cryptogenic ischaemic stroke over a 1-year period were included (n = 164). Patients were prospectively followed up at the outpatient clinic. Information on long-term outcome included the presence of newly diagnosed AF (NDAF). A specific NDAF assessment was performed at least 2 years after the index stroke using a structured telephone interview. Baseline clinical, laboratory, and echocardiographic data of these patients were retrospectively recorded. Independent predictive factors were then used to produce a predictive grading score for NDAF, derived by logistic regression analysis.

RESULTS:

With a median follow-up of 854 days, 22 cases of NDAF (13%) were observed. On multivariate analysis, factors associated with NDAF were age ≥72 years (two points), history of coronary artery disease (one point) or stroke (one point), and left atrial area ≥16 cm(2) (two points) (total score ranging from 0 to 6). Patients with a score ≤1 point did not have NDAF during follow-up.

CONCLUSIONS:

In cryptogenic ischaemic stroke, the NDAF score can be used to target patients at high risk of developing AF after hospital discharge, as a score of 0-1 was highly predictive of the absence of NDAF during follow-up. These results need to be confirmed in prospective studies.

KEYWORDS:

atrial fibrillation; ischaemic stroke; outcome; secondary prevention

PMID:
23121252
DOI:
10.1111/ene.12017
[Indexed for MEDLINE]

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