Biomarkers of Atrial Cardiopathy and Atrial Fibrillation Detection on Mobile Outpatient Continuous Telemetry After Embolic Stroke of Undetermined Source
Background Biomarkers of atrial dysfunction or “cardiopathy” are associated with embolic stroke risk. However, it is unclear if this risk is mediated by undiagnosed paroxysmal atrial fibrillation or flutter (AF). We aim to determine whether atrial cardiopathy biomarkers predict AF on continuous hear...
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| creator | Sebasigari, Denise, MD Merkler, Alexander, MD Guo, Yang, BS Gialdini, Gino, MD Kummer, Benjamin, MD Hemendinger, Morgan, BS Song, Christopher, MD Chu, Antony, MD Cutting, Shawna, MD Silver, Brian, MD Elkind, Mitchell S.V., MD Kamel, Hooman, MD Furie, Karen L., MD Yaghi, Shadi, MD |
| description | Background Biomarkers of atrial dysfunction or “cardiopathy” are associated with embolic stroke risk. However, it is unclear if this risk is mediated by undiagnosed paroxysmal atrial fibrillation or flutter (AF). We aim to determine whether atrial cardiopathy biomarkers predict AF on continuous heart-rhythm monitoring after embolic stroke of undetermined source (ESUS). Methods This was a single-center retrospective study including all patients with ESUS undergoing 30 days of ambulatory heart-rhythm monitoring to look for AF between January 1, 2013 and December 31, 2015. We reviewed medical records for clinical, radiographic, and cardiac variables. The primary outcome was a new diagnosis of AF detected during heart-rhythm monitoring. The primary predictors were atrial biomarkers: left atrial diameter on echocardiography, P-wave terminal force in electrocardiogram (ECG) lead V1, and P wave - R wave (PR) interval on ECG. A multiple logistic regression model was used to assess the relationship between atrial biomarkers and AF detection. Results Among 196 eligible patients, 23 (11.7%) were diagnosed with AF. In unadjusted analyses, patients with AF were older (72.4 years versus 61.4 years, P |
| doi_str_mv | 10.1016/j.jstrokecerebrovasdis.2017.01.016 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1872575981</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S1052305717300344</els_id><sourcerecordid>1872575981</sourcerecordid><originalsourceid>FETCH-LOGICAL-c525t-ec740fa340da1981d7108724f70b02706bb1eef7b926a9e4ffd80aad4594d823</originalsourceid><addsrcrecordid>eNqVUsGO0zAQjRCIXRZ-AfmIkFI8ThynF6Ru2QWkoj20nC3Hngi3iV1sZ6X-CZ-Ls93lgLggjeSR9fye570pivdAF0Ch-bBf7GMK_oAaA3bB36tobFwwCmJBIVfzrLgEXrGy5QDPc085KyvKxUXxKsY9pQC85S-LC9aySgDjl8Wva-tHFQ4YIvE9WaVg1UDWKhjrjyr9OBHlzNP1re2CHQaVrHfkEybUD12ub76zA5K7KeVHFl0ia--SdZOfItnhgCOmcCKrPmEgN2PnB6vJ9mGYWfa7M5ktjNahIVs_BY2vixe9GiK-eTyvit3tzW79pdzcff66Xm1KzRlPJWpR015VNTUKli0YAbQVrO4F7SgTtOk6QOxFt2SNWmLd96alSpmaL2uTXbgq3p1pj8H_nDAmOdqoMQ_pMP9dQibjgmfmDL0-Q3XwMQbs5THY7N1JApVzQHIv_xWQnAOSFHI1meTto97UjWj-UDwlkgGbMwDz0PcWg4w6G6rR2JD9lsbb_9P7-BedHqyzWg0HPGHcZ69dtleCjExSuZ1XZt4YEBWlVV1XvwG2KMh6</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1872575981</pqid></control><display><type>article</type><title>Biomarkers of Atrial Cardiopathy and Atrial Fibrillation Detection on Mobile Outpatient Continuous Telemetry After Embolic Stroke of Undetermined Source</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Sebasigari, Denise, MD ; Merkler, Alexander, MD ; Guo, Yang, BS ; Gialdini, Gino, MD ; Kummer, Benjamin, MD ; Hemendinger, Morgan, BS ; Song, Christopher, MD ; Chu, Antony, MD ; Cutting, Shawna, MD ; Silver, Brian, MD ; Elkind, Mitchell S.V., MD ; Kamel, Hooman, MD ; Furie, Karen L., MD ; Yaghi, Shadi, MD</creator><creatorcontrib>Sebasigari, Denise, MD ; Merkler, Alexander, MD ; Guo, Yang, BS ; Gialdini, Gino, MD ; Kummer, Benjamin, MD ; Hemendinger, Morgan, BS ; Song, Christopher, MD ; Chu, Antony, MD ; Cutting, Shawna, MD ; Silver, Brian, MD ; Elkind, Mitchell S.V., MD ; Kamel, Hooman, MD ; Furie, Karen L., MD ; Yaghi, Shadi, MD</creatorcontrib><description>Background Biomarkers of atrial dysfunction or “cardiopathy” are associated with embolic stroke risk. However, it is unclear if this risk is mediated by undiagnosed paroxysmal atrial fibrillation or flutter (AF). We aim to determine whether atrial cardiopathy biomarkers predict AF on continuous heart-rhythm monitoring after embolic stroke of undetermined source (ESUS). Methods This was a single-center retrospective study including all patients with ESUS undergoing 30 days of ambulatory heart-rhythm monitoring to look for AF between January 1, 2013 and December 31, 2015. We reviewed medical records for clinical, radiographic, and cardiac variables. The primary outcome was a new diagnosis of AF detected during heart-rhythm monitoring. The primary predictors were atrial biomarkers: left atrial diameter on echocardiography, P-wave terminal force in electrocardiogram (ECG) lead V1, and P wave - R wave (PR) interval on ECG. A multiple logistic regression model was used to assess the relationship between atrial biomarkers and AF detection. Results Among 196 eligible patients, 23 (11.7%) were diagnosed with AF. In unadjusted analyses, patients with AF were older (72.4 years versus 61.4 years, P < .001) and had larger left atrial diameter (39.2 mm versus 35.7 mm, P = .03). In a multivariable model, the only predictor of AF was age ≥ 60 years (odds ratio, 3.0; 95% CI, 1.06-8.5; P = .04). Conclusion Atrial biomarkers were weakly associated with AF after ESUS. This suggests that previously reported associations between these markers and stroke may reflect independent cardiac pathways leading to stroke. Prospective studies are needed to investigate these mechanisms.</description><identifier>ISSN: 1052-3057</identifier><identifier>EISSN: 1532-8511</identifier><identifier>DOI: 10.1016/j.jstrokecerebrovasdis.2017.01.016</identifier><identifier>PMID: 28237125</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Ambulatory Care - methods ; atrial cardiopathy ; atrial fibrillation ; Atrial Fibrillation - complications ; Atrial Fibrillation - diagnosis ; Atrial Fibrillation - physiopathology ; Atrial Flutter - complications ; Atrial Flutter - diagnosis ; Atrial Flutter - physiopathology ; Atrial Function, Right ; Cardiovascular ; Cryptogenic stroke ; Echocardiography ; Electrocardiography, Ambulatory ; embolic stroke of undetermined source ; Female ; Heart Atria - diagnostic imaging ; Heart Atria - physiopathology ; Heart Rate ; Humans ; Intracranial Embolism - diagnosis ; Intracranial Embolism - etiology ; ischemic stroke ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Neurology ; Odds Ratio ; Predictive Value of Tests ; Prognosis ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Stroke - diagnosis ; Stroke - etiology ; Telemetry - methods ; Ventricular Function, Left</subject><ispartof>Journal of stroke and cerebrovascular diseases, 2017-06, Vol.26 (6), p.1249-1253</ispartof><rights>National Stroke Association</rights><rights>2017 National Stroke Association</rights><rights>Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c525t-ec740fa340da1981d7108724f70b02706bb1eef7b926a9e4ffd80aad4594d823</citedby><cites>FETCH-LOGICAL-c525t-ec740fa340da1981d7108724f70b02706bb1eef7b926a9e4ffd80aad4594d823</cites><orcidid>0000-0003-0031-1004</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1052305717300344$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28237125$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sebasigari, Denise, MD</creatorcontrib><creatorcontrib>Merkler, Alexander, MD</creatorcontrib><creatorcontrib>Guo, Yang, BS</creatorcontrib><creatorcontrib>Gialdini, Gino, MD</creatorcontrib><creatorcontrib>Kummer, Benjamin, MD</creatorcontrib><creatorcontrib>Hemendinger, Morgan, BS</creatorcontrib><creatorcontrib>Song, Christopher, MD</creatorcontrib><creatorcontrib>Chu, Antony, MD</creatorcontrib><creatorcontrib>Cutting, Shawna, MD</creatorcontrib><creatorcontrib>Silver, Brian, MD</creatorcontrib><creatorcontrib>Elkind, Mitchell S.V., MD</creatorcontrib><creatorcontrib>Kamel, Hooman, MD</creatorcontrib><creatorcontrib>Furie, Karen L., MD</creatorcontrib><creatorcontrib>Yaghi, Shadi, MD</creatorcontrib><title>Biomarkers of Atrial Cardiopathy and Atrial Fibrillation Detection on Mobile Outpatient Continuous Telemetry After Embolic Stroke of Undetermined Source</title><title>Journal of stroke and cerebrovascular diseases</title><addtitle>J Stroke Cerebrovasc Dis</addtitle><description>Background Biomarkers of atrial dysfunction or “cardiopathy” are associated with embolic stroke risk. However, it is unclear if this risk is mediated by undiagnosed paroxysmal atrial fibrillation or flutter (AF). We aim to determine whether atrial cardiopathy biomarkers predict AF on continuous heart-rhythm monitoring after embolic stroke of undetermined source (ESUS). Methods This was a single-center retrospective study including all patients with ESUS undergoing 30 days of ambulatory heart-rhythm monitoring to look for AF between January 1, 2013 and December 31, 2015. We reviewed medical records for clinical, radiographic, and cardiac variables. The primary outcome was a new diagnosis of AF detected during heart-rhythm monitoring. The primary predictors were atrial biomarkers: left atrial diameter on echocardiography, P-wave terminal force in electrocardiogram (ECG) lead V1, and P wave - R wave (PR) interval on ECG. A multiple logistic regression model was used to assess the relationship between atrial biomarkers and AF detection. Results Among 196 eligible patients, 23 (11.7%) were diagnosed with AF. In unadjusted analyses, patients with AF were older (72.4 years versus 61.4 years, P < .001) and had larger left atrial diameter (39.2 mm versus 35.7 mm, P = .03). In a multivariable model, the only predictor of AF was age ≥ 60 years (odds ratio, 3.0; 95% CI, 1.06-8.5; P = .04). Conclusion Atrial biomarkers were weakly associated with AF after ESUS. This suggests that previously reported associations between these markers and stroke may reflect independent cardiac pathways leading to stroke. Prospective studies are needed to investigate these mechanisms.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Ambulatory Care - methods</subject><subject>atrial cardiopathy</subject><subject>atrial fibrillation</subject><subject>Atrial Fibrillation - complications</subject><subject>Atrial Fibrillation - diagnosis</subject><subject>Atrial Fibrillation - physiopathology</subject><subject>Atrial Flutter - complications</subject><subject>Atrial Flutter - diagnosis</subject><subject>Atrial Flutter - physiopathology</subject><subject>Atrial Function, Right</subject><subject>Cardiovascular</subject><subject>Cryptogenic stroke</subject><subject>Echocardiography</subject><subject>Electrocardiography, Ambulatory</subject><subject>embolic stroke of undetermined source</subject><subject>Female</subject><subject>Heart Atria - diagnostic imaging</subject><subject>Heart Atria - physiopathology</subject><subject>Heart Rate</subject><subject>Humans</subject><subject>Intracranial Embolism - diagnosis</subject><subject>Intracranial Embolism - etiology</subject><subject>ischemic stroke</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Neurology</subject><subject>Odds Ratio</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Stroke - diagnosis</subject><subject>Stroke - etiology</subject><subject>Telemetry - methods</subject><subject>Ventricular Function, Left</subject><issn>1052-3057</issn><issn>1532-8511</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqVUsGO0zAQjRCIXRZ-AfmIkFI8ThynF6Ru2QWkoj20nC3Hngi3iV1sZ6X-CZ-Ls93lgLggjeSR9fye570pivdAF0Ch-bBf7GMK_oAaA3bB36tobFwwCmJBIVfzrLgEXrGy5QDPc085KyvKxUXxKsY9pQC85S-LC9aySgDjl8Wva-tHFQ4YIvE9WaVg1UDWKhjrjyr9OBHlzNP1re2CHQaVrHfkEybUD12ub76zA5K7KeVHFl0ia--SdZOfItnhgCOmcCKrPmEgN2PnB6vJ9mGYWfa7M5ktjNahIVs_BY2vixe9GiK-eTyvit3tzW79pdzcff66Xm1KzRlPJWpR015VNTUKli0YAbQVrO4F7SgTtOk6QOxFt2SNWmLd96alSpmaL2uTXbgq3p1pj8H_nDAmOdqoMQ_pMP9dQibjgmfmDL0-Q3XwMQbs5THY7N1JApVzQHIv_xWQnAOSFHI1meTto97UjWj-UDwlkgGbMwDz0PcWg4w6G6rR2JD9lsbb_9P7-BedHqyzWg0HPGHcZ69dtleCjExSuZ1XZt4YEBWlVV1XvwG2KMh6</recordid><startdate>20170601</startdate><enddate>20170601</enddate><creator>Sebasigari, Denise, MD</creator><creator>Merkler, Alexander, MD</creator><creator>Guo, Yang, BS</creator><creator>Gialdini, Gino, MD</creator><creator>Kummer, Benjamin, MD</creator><creator>Hemendinger, Morgan, BS</creator><creator>Song, Christopher, MD</creator><creator>Chu, Antony, MD</creator><creator>Cutting, Shawna, MD</creator><creator>Silver, Brian, MD</creator><creator>Elkind, Mitchell S.V., MD</creator><creator>Kamel, Hooman, MD</creator><creator>Furie, Karen L., MD</creator><creator>Yaghi, Shadi, MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0031-1004</orcidid></search><sort><creationdate>20170601</creationdate><title>Biomarkers of Atrial Cardiopathy and Atrial Fibrillation Detection on Mobile Outpatient Continuous Telemetry After Embolic Stroke of Undetermined Source</title><author>Sebasigari, Denise, MD ; Merkler, Alexander, MD ; Guo, Yang, BS ; Gialdini, Gino, MD ; Kummer, Benjamin, MD ; Hemendinger, Morgan, BS ; Song, Christopher, MD ; Chu, Antony, MD ; Cutting, Shawna, MD ; Silver, Brian, MD ; Elkind, Mitchell S.V., MD ; Kamel, Hooman, MD ; Furie, Karen L., MD ; Yaghi, Shadi, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c525t-ec740fa340da1981d7108724f70b02706bb1eef7b926a9e4ffd80aad4594d823</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Ambulatory Care - methods</topic><topic>atrial cardiopathy</topic><topic>atrial fibrillation</topic><topic>Atrial Fibrillation - complications</topic><topic>Atrial Fibrillation - diagnosis</topic><topic>Atrial Fibrillation - physiopathology</topic><topic>Atrial Flutter - complications</topic><topic>Atrial Flutter - diagnosis</topic><topic>Atrial Flutter - physiopathology</topic><topic>Atrial Function, Right</topic><topic>Cardiovascular</topic><topic>Cryptogenic stroke</topic><topic>Echocardiography</topic><topic>Electrocardiography, Ambulatory</topic><topic>embolic stroke of undetermined source</topic><topic>Female</topic><topic>Heart Atria - diagnostic imaging</topic><topic>Heart Atria - physiopathology</topic><topic>Heart Rate</topic><topic>Humans</topic><topic>Intracranial Embolism - diagnosis</topic><topic>Intracranial Embolism - etiology</topic><topic>ischemic stroke</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Neurology</topic><topic>Odds Ratio</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Stroke - diagnosis</topic><topic>Stroke - etiology</topic><topic>Telemetry - methods</topic><topic>Ventricular Function, Left</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sebasigari, Denise, MD</creatorcontrib><creatorcontrib>Merkler, Alexander, MD</creatorcontrib><creatorcontrib>Guo, Yang, BS</creatorcontrib><creatorcontrib>Gialdini, Gino, MD</creatorcontrib><creatorcontrib>Kummer, Benjamin, MD</creatorcontrib><creatorcontrib>Hemendinger, Morgan, BS</creatorcontrib><creatorcontrib>Song, Christopher, MD</creatorcontrib><creatorcontrib>Chu, Antony, MD</creatorcontrib><creatorcontrib>Cutting, Shawna, MD</creatorcontrib><creatorcontrib>Silver, Brian, MD</creatorcontrib><creatorcontrib>Elkind, Mitchell S.V., MD</creatorcontrib><creatorcontrib>Kamel, Hooman, MD</creatorcontrib><creatorcontrib>Furie, Karen L., MD</creatorcontrib><creatorcontrib>Yaghi, Shadi, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of stroke and cerebrovascular diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sebasigari, Denise, MD</au><au>Merkler, Alexander, MD</au><au>Guo, Yang, BS</au><au>Gialdini, Gino, MD</au><au>Kummer, Benjamin, MD</au><au>Hemendinger, Morgan, BS</au><au>Song, Christopher, MD</au><au>Chu, Antony, MD</au><au>Cutting, Shawna, MD</au><au>Silver, Brian, MD</au><au>Elkind, Mitchell S.V., MD</au><au>Kamel, Hooman, MD</au><au>Furie, Karen L., MD</au><au>Yaghi, Shadi, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Biomarkers of Atrial Cardiopathy and Atrial Fibrillation Detection on Mobile Outpatient Continuous Telemetry After Embolic Stroke of Undetermined Source</atitle><jtitle>Journal of stroke and cerebrovascular diseases</jtitle><addtitle>J Stroke Cerebrovasc Dis</addtitle><date>2017-06-01</date><risdate>2017</risdate><volume>26</volume><issue>6</issue><spage>1249</spage><epage>1253</epage><pages>1249-1253</pages><issn>1052-3057</issn><eissn>1532-8511</eissn><abstract>Background Biomarkers of atrial dysfunction or “cardiopathy” are associated with embolic stroke risk. However, it is unclear if this risk is mediated by undiagnosed paroxysmal atrial fibrillation or flutter (AF). We aim to determine whether atrial cardiopathy biomarkers predict AF on continuous heart-rhythm monitoring after embolic stroke of undetermined source (ESUS). Methods This was a single-center retrospective study including all patients with ESUS undergoing 30 days of ambulatory heart-rhythm monitoring to look for AF between January 1, 2013 and December 31, 2015. We reviewed medical records for clinical, radiographic, and cardiac variables. The primary outcome was a new diagnosis of AF detected during heart-rhythm monitoring. The primary predictors were atrial biomarkers: left atrial diameter on echocardiography, P-wave terminal force in electrocardiogram (ECG) lead V1, and P wave - R wave (PR) interval on ECG. A multiple logistic regression model was used to assess the relationship between atrial biomarkers and AF detection. Results Among 196 eligible patients, 23 (11.7%) were diagnosed with AF. In unadjusted analyses, patients with AF were older (72.4 years versus 61.4 years, P < .001) and had larger left atrial diameter (39.2 mm versus 35.7 mm, P = .03). In a multivariable model, the only predictor of AF was age ≥ 60 years (odds ratio, 3.0; 95% CI, 1.06-8.5; P = .04). Conclusion Atrial biomarkers were weakly associated with AF after ESUS. This suggests that previously reported associations between these markers and stroke may reflect independent cardiac pathways leading to stroke. Prospective studies are needed to investigate these mechanisms.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28237125</pmid><doi>10.1016/j.jstrokecerebrovasdis.2017.01.016</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0003-0031-1004</orcidid></addata></record> |
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| subjects | Aged Aged, 80 and over Ambulatory Care - methods atrial cardiopathy atrial fibrillation Atrial Fibrillation - complications Atrial Fibrillation - diagnosis Atrial Fibrillation - physiopathology Atrial Flutter - complications Atrial Flutter - diagnosis Atrial Flutter - physiopathology Atrial Function, Right Cardiovascular Cryptogenic stroke Echocardiography Electrocardiography, Ambulatory embolic stroke of undetermined source Female Heart Atria - diagnostic imaging Heart Atria - physiopathology Heart Rate Humans Intracranial Embolism - diagnosis Intracranial Embolism - etiology ischemic stroke Logistic Models Male Middle Aged Multivariate Analysis Neurology Odds Ratio Predictive Value of Tests Prognosis Retrospective Studies Risk Assessment Risk Factors Stroke - diagnosis Stroke - etiology Telemetry - methods Ventricular Function, Left |
| title | Biomarkers of Atrial Cardiopathy and Atrial Fibrillation Detection on Mobile Outpatient Continuous Telemetry After Embolic Stroke of Undetermined Source |
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