Performance of Different Risk Scores for the Detection of Atrial Fibrillation Among Patients With Cryptogenic Stroke-Reference-Cited by-同舟云学术

Performance of Different Risk Scores for the Detection of Atrial Fibrillation Among Patients With Cryptogenic Stroke

Published:2024-02 Issue:2 Volume:55 Page:454-462
ISSN:0039-2499
Container-title:Stroke
language:en
Short-container-title:Stroke

Author:

Palaiodimou Lina¹^ORCID,Theodorou Aikaterini¹^ORCID,Triantafyllou Sokratis¹^ORCID,Dilaveris Polychronis²^ORCID,Flevari Panagiota³,Giannopoulos Georgios⁴^ORCID,Kossyvakis Charalampos⁵^ORCID,Adreanides Elias⁶^ORCID,Tympas Konstantinos³,Nikolopoulos Petros³,Zompola Christina¹^ORCID,Bakola Eleni¹^ORCID,Chondrogianni Maria¹^ORCID,Magiorkinis Gkikas⁷,Deftereos Spyridon³,Giannopoulos Sotirios¹^ORCID,Tsioufis Konstantinos²^ORCID,Filippatos Gerasimos³^ORCID,Tsivgoulis Georgios¹⁸^ORCID

Affiliation:

1. Second Department of Neurology (L.P., A.T., S.T., C.Z., E.B., M.C., S.G., G.T.), Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece.

2. First Department of Cardiology, Hippokration Hospital, Athens Medical School (P.D., K. Tsioufis), National and Kapodistrian University of Athens, Greece.

3. Second Department of Cardiology (P.F., K. Tympas, P.N., S.D., G.F.), Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece.

4. Third Department of Cardiology, Aristotle University of Thessaloniki, Greece (G.G.).

5. Department of Cardiology, General Hospital of Athens “Georgios Gennimatas,” Greece (C.K.).

6. Department of Cardiology, Medical Institution Military Shareholder Fund, Athens, Greece (E.A.).

7. Department of Hygiene, Epidemiology and Medical Statistics, Medical School (G.M.), National and Kapodistrian University of Athens, Greece.

8. Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T.).

Abstract

BACKGROUND: Atrial fibrillation (AF) is a frequent underlying cause of cryptogenic stroke (CS) and its detection can be increased using implantable cardiac monitoring (ICM). We sought to evaluate different risk scores and assess their diagnostic ability in identifying patients with CS with underlying AF on ICM. METHODS: Patients with CS, being admitted to a single tertiary stroke center between 2017 and 2022 and receiving ICM, were prospectively evaluated. The CHA 2 DS 2 -VASc, HAVOC, Brown ESUS-AF, and C 2 HEST scores were calculated at baseline. The primary outcome of interest was the detection of AF, which was defined as at least 1 AF episode on ICM lasting for 2 consecutive minutes or more. The diagnostic accuracy measures and the net reclassification improvement were calculated for the 4 risk scores. Stroke recurrence was evaluated as a secondary outcome. RESULTS: A total of 250 patients with CS were included, and AF was detected by ICM in 20.4% (n=51) during a median monitoring period of 16 months. Patients with CS with AF detection were older compared with the rest ( P =0.045). The median HAVOC, Brown ESUS-AF, and C 2 HEST scores were higher among the patients with AF compared with the patients without AF (all P <0.05), while the median CHA 2 DS 2 -VASc score was similar between the 2 groups. The corresponding C statistics for CHA 2 DS 2 -VASc, HAVOC, Brown ESUS-AF, and C 2 HEST for AF prediction were 0.576 (95% CI, 0.482–0.670), 0.612 (95% CI, 0.523–0.700), 0.666 (95% CI, 0.587–0.746), and 0.770 (95% CI, 0.699–0.839). The C 2 HEST score presented the highest diagnostic performance based on C statistics ( P <0.05 after correction for multiple comparisons) and provided significant improvement in net reclassification for AF detection (>70%) compared with the other risk scores. Finally, stroke recurrence was documented in 5.6% of the study population, with no difference regarding the 4 risk scores between patients with and without recurrent stroke. CONCLUSIONS: The C 2 HEST score was superior to the CHA 2 DS 2 -VASc, HAVOC, and Brown ESUS-AF scores for discriminating patients with CS with underlying AF using ICM.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

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