Multiparametric identification of subclinical atrial fibrillation after an embolic stroke of undetermined source
Background Subclinical atrial fibrillation (SCAF) may represent a cause of embolic stroke of undetermined source (ESUS) and its detection has important implications for secondary prevention with anticoagulation. Indications to implantable cardiac monitors (ICM) include SCAF detection. The aims of th...
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| Veröffentlicht in: | Neurological sciences 2023-03, Vol.44 (3), p.979-988 |
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| creator | Del Monte, Alvise Rivezzi, Francesco Giacomin, Enrico Peruzza, Francesco Del Greco, Maurizio Maines, Massimiliano Migliore, Federico Zorzi, Alessandro Viaro, Federica Pieroni, Alessio La Licata, Andrea Baracchini, Claudio Bertaglia, Emanuele |
| description | Background
Subclinical atrial fibrillation (SCAF) may represent a cause of embolic stroke of undetermined source (ESUS) and its detection has important implications for secondary prevention with anticoagulation. Indications to implantable cardiac monitors (ICM) include SCAF detection. The aims of this study were to (1) evaluate the frequency of ICM-detected SCAF; (2) determine predictors of SCAF; and (3) identify patients who would benefit most from ICM implantation.
Methods
Between February 2017 and November 2020, all consecutive patients referred for ICM implantation after a diagnosis of ESUS and without previous history of atrial fibrillation or atrial flutter were included in this study. SCAF was diagnosed if the ICM electrogram demonstrated an episode of irregularly irregular rhythm without distinct P waves lasting > 2 min.
Results
We enrolled 109 patients (age 66, SD = 13 years; 36% females). During a median follow-up of 19.2 (IQR 11.0–27.5) months, SCAF episodes were detected in 36 (33%) patients. Only abnormal P wave terminal force in lead V1, left atrial end-systolic indexed volume > 34 ml/m
2
, and BMI > 25 kg/m
2
were independently associated with an increased risk of SCAF (HR 2.44, 95% CI 1.14–5.21,
p
= 0.021; HR 2.39, 95% CI 1.11–5.13,
p
= 0.026; and HR 2.64, 95% CI 1.06–6.49,
p
= 0.036 respectively). The ROC curve showed that the presence of all three parameters had the best accuracy (74%) to predict SCAF detection (sensitivity 39%, specificity 91%).
Conclusion
A multiparametric evaluation has the best accuracy to predict SCAF in ESUS patients and may help identifying those who would benefit most from ICM. |
| doi_str_mv | 10.1007/s10072-022-06501-1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2737117404</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2775851270</sourcerecordid><originalsourceid>FETCH-LOGICAL-c305t-2cb73b09015ed8f3007130c6e66b61bae909e4e653c5039a68376784c9afd1903</originalsourceid><addsrcrecordid>eNp9kUtPxSAQhYnR6PXxB1yYJm7cVGdKC-3SGF_JNW50TSidGrSlV2gX_nu59qqJCxcwhPnOYchh7BjhHAHkRVjvWQpZXKIATHGLLbCoIOW5LLc3Zyxlvsf2Q3gFAMyR77I9LnjJM5Ev2Oph6ka70l73NHprEtuQG21rjR7t4JKhTcJUm866eNMlOjKxtLb2tutmRLcj-US7hPp66KJFGP3wRmvp5BqKzd46apIwTN7QIdtpdRfoaFMP2PPN9dPVXbp8vL2_ulymhkMxppmpJa-hAiyoKVsef4ocjCAhaoG1pgoqykkU3BTAKy1KLoUsc1PptsEK-AE7m31XfnifKIyqt8FQHNrRMAWVSS4RZQ55RE__oK9xVBeni5QsygIzuTbMZsr4IQRPrVp522v_oRDUOgk156FiHuorD4VRdLKxnuqemh_JdwAR4DMQYsu9kP99-x_bT4Evlmk</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2775851270</pqid></control><display><type>article</type><title>Multiparametric identification of subclinical atrial fibrillation after an embolic stroke of undetermined source</title><source>MEDLINE</source><source>SpringerLink</source><creator>Del Monte, Alvise ; Rivezzi, Francesco ; Giacomin, Enrico ; Peruzza, Francesco ; Del Greco, Maurizio ; Maines, Massimiliano ; Migliore, Federico ; Zorzi, Alessandro ; Viaro, Federica ; Pieroni, Alessio ; La Licata, Andrea ; Baracchini, Claudio ; Bertaglia, Emanuele</creator><creatorcontrib>Del Monte, Alvise ; Rivezzi, Francesco ; Giacomin, Enrico ; Peruzza, Francesco ; Del Greco, Maurizio ; Maines, Massimiliano ; Migliore, Federico ; Zorzi, Alessandro ; Viaro, Federica ; Pieroni, Alessio ; La Licata, Andrea ; Baracchini, Claudio ; Bertaglia, Emanuele</creatorcontrib><description>Background
Subclinical atrial fibrillation (SCAF) may represent a cause of embolic stroke of undetermined source (ESUS) and its detection has important implications for secondary prevention with anticoagulation. Indications to implantable cardiac monitors (ICM) include SCAF detection. The aims of this study were to (1) evaluate the frequency of ICM-detected SCAF; (2) determine predictors of SCAF; and (3) identify patients who would benefit most from ICM implantation.
Methods
Between February 2017 and November 2020, all consecutive patients referred for ICM implantation after a diagnosis of ESUS and without previous history of atrial fibrillation or atrial flutter were included in this study. SCAF was diagnosed if the ICM electrogram demonstrated an episode of irregularly irregular rhythm without distinct P waves lasting > 2 min.
Results
We enrolled 109 patients (age 66, SD = 13 years; 36% females). During a median follow-up of 19.2 (IQR 11.0–27.5) months, SCAF episodes were detected in 36 (33%) patients. Only abnormal P wave terminal force in lead V1, left atrial end-systolic indexed volume > 34 ml/m
2
, and BMI > 25 kg/m
2
were independently associated with an increased risk of SCAF (HR 2.44, 95% CI 1.14–5.21,
p
= 0.021; HR 2.39, 95% CI 1.11–5.13,
p
= 0.026; and HR 2.64, 95% CI 1.06–6.49,
p
= 0.036 respectively). The ROC curve showed that the presence of all three parameters had the best accuracy (74%) to predict SCAF detection (sensitivity 39%, specificity 91%).
Conclusion
A multiparametric evaluation has the best accuracy to predict SCAF in ESUS patients and may help identifying those who would benefit most from ICM.</description><identifier>ISSN: 1590-1874</identifier><identifier>EISSN: 1590-3478</identifier><identifier>DOI: 10.1007/s10072-022-06501-1</identifier><identifier>PMID: 36383264</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Aged ; Atrial Fibrillation - complications ; Atrial Fibrillation - diagnosis ; Cardiac arrhythmia ; Electrocardiography - adverse effects ; Embolic Stroke - complications ; Female ; Fibrillation ; Humans ; Male ; Medicine ; Medicine & Public Health ; Neurology ; Neuroradiology ; Neurosciences ; Neurosurgery ; Original Article ; Psychiatry ; Risk Factors ; Stroke ; Stroke - complications ; Stroke - diagnosis</subject><ispartof>Neurological sciences, 2023-03, Vol.44 (3), p.979-988</ispartof><rights>Fondazione Società Italiana di Neurologia 2022. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2022. Fondazione Società Italiana di Neurologia.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c305t-2cb73b09015ed8f3007130c6e66b61bae909e4e653c5039a68376784c9afd1903</citedby><cites>FETCH-LOGICAL-c305t-2cb73b09015ed8f3007130c6e66b61bae909e4e653c5039a68376784c9afd1903</cites><orcidid>0000-0002-3878-2904</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10072-022-06501-1$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10072-022-06501-1$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,777,781,27905,27906,41469,42538,51300</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36383264$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Del Monte, Alvise</creatorcontrib><creatorcontrib>Rivezzi, Francesco</creatorcontrib><creatorcontrib>Giacomin, Enrico</creatorcontrib><creatorcontrib>Peruzza, Francesco</creatorcontrib><creatorcontrib>Del Greco, Maurizio</creatorcontrib><creatorcontrib>Maines, Massimiliano</creatorcontrib><creatorcontrib>Migliore, Federico</creatorcontrib><creatorcontrib>Zorzi, Alessandro</creatorcontrib><creatorcontrib>Viaro, Federica</creatorcontrib><creatorcontrib>Pieroni, Alessio</creatorcontrib><creatorcontrib>La Licata, Andrea</creatorcontrib><creatorcontrib>Baracchini, Claudio</creatorcontrib><creatorcontrib>Bertaglia, Emanuele</creatorcontrib><title>Multiparametric identification of subclinical atrial fibrillation after an embolic stroke of undetermined source</title><title>Neurological sciences</title><addtitle>Neurol Sci</addtitle><addtitle>Neurol Sci</addtitle><description>Background
Subclinical atrial fibrillation (SCAF) may represent a cause of embolic stroke of undetermined source (ESUS) and its detection has important implications for secondary prevention with anticoagulation. Indications to implantable cardiac monitors (ICM) include SCAF detection. The aims of this study were to (1) evaluate the frequency of ICM-detected SCAF; (2) determine predictors of SCAF; and (3) identify patients who would benefit most from ICM implantation.
Methods
Between February 2017 and November 2020, all consecutive patients referred for ICM implantation after a diagnosis of ESUS and without previous history of atrial fibrillation or atrial flutter were included in this study. SCAF was diagnosed if the ICM electrogram demonstrated an episode of irregularly irregular rhythm without distinct P waves lasting > 2 min.
Results
We enrolled 109 patients (age 66, SD = 13 years; 36% females). During a median follow-up of 19.2 (IQR 11.0–27.5) months, SCAF episodes were detected in 36 (33%) patients. Only abnormal P wave terminal force in lead V1, left atrial end-systolic indexed volume > 34 ml/m
2
, and BMI > 25 kg/m
2
were independently associated with an increased risk of SCAF (HR 2.44, 95% CI 1.14–5.21,
p
= 0.021; HR 2.39, 95% CI 1.11–5.13,
p
= 0.026; and HR 2.64, 95% CI 1.06–6.49,
p
= 0.036 respectively). The ROC curve showed that the presence of all three parameters had the best accuracy (74%) to predict SCAF detection (sensitivity 39%, specificity 91%).
Conclusion
A multiparametric evaluation has the best accuracy to predict SCAF in ESUS patients and may help identifying those who would benefit most from ICM.</description><subject>Aged</subject><subject>Atrial Fibrillation - complications</subject><subject>Atrial Fibrillation - diagnosis</subject><subject>Cardiac arrhythmia</subject><subject>Electrocardiography - adverse effects</subject><subject>Embolic Stroke - complications</subject><subject>Female</subject><subject>Fibrillation</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neurology</subject><subject>Neuroradiology</subject><subject>Neurosciences</subject><subject>Neurosurgery</subject><subject>Original Article</subject><subject>Psychiatry</subject><subject>Risk Factors</subject><subject>Stroke</subject><subject>Stroke - complications</subject><subject>Stroke - diagnosis</subject><issn>1590-1874</issn><issn>1590-3478</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp9kUtPxSAQhYnR6PXxB1yYJm7cVGdKC-3SGF_JNW50TSidGrSlV2gX_nu59qqJCxcwhPnOYchh7BjhHAHkRVjvWQpZXKIATHGLLbCoIOW5LLc3Zyxlvsf2Q3gFAMyR77I9LnjJM5Ev2Oph6ka70l73NHprEtuQG21rjR7t4JKhTcJUm866eNMlOjKxtLb2tutmRLcj-US7hPp66KJFGP3wRmvp5BqKzd46apIwTN7QIdtpdRfoaFMP2PPN9dPVXbp8vL2_ulymhkMxppmpJa-hAiyoKVsef4ocjCAhaoG1pgoqykkU3BTAKy1KLoUsc1PptsEK-AE7m31XfnifKIyqt8FQHNrRMAWVSS4RZQ55RE__oK9xVBeni5QsygIzuTbMZsr4IQRPrVp522v_oRDUOgk156FiHuorD4VRdLKxnuqemh_JdwAR4DMQYsu9kP99-x_bT4Evlmk</recordid><startdate>20230301</startdate><enddate>20230301</enddate><creator>Del Monte, Alvise</creator><creator>Rivezzi, Francesco</creator><creator>Giacomin, Enrico</creator><creator>Peruzza, Francesco</creator><creator>Del Greco, Maurizio</creator><creator>Maines, Massimiliano</creator><creator>Migliore, Federico</creator><creator>Zorzi, Alessandro</creator><creator>Viaro, Federica</creator><creator>Pieroni, Alessio</creator><creator>La Licata, Andrea</creator><creator>Baracchini, Claudio</creator><creator>Bertaglia, Emanuele</creator><general>Springer International Publishing</general><general>Springer Nature B.V</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>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9-</scope><scope>K9.</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-3878-2904</orcidid></search><sort><creationdate>20230301</creationdate><title>Multiparametric identification of subclinical atrial fibrillation after an embolic stroke of undetermined source</title><author>Del Monte, Alvise ; Rivezzi, Francesco ; Giacomin, Enrico ; Peruzza, Francesco ; Del Greco, Maurizio ; Maines, Massimiliano ; Migliore, Federico ; Zorzi, Alessandro ; Viaro, Federica ; Pieroni, Alessio ; La Licata, Andrea ; Baracchini, Claudio ; Bertaglia, Emanuele</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c305t-2cb73b09015ed8f3007130c6e66b61bae909e4e653c5039a68376784c9afd1903</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Aged</topic><topic>Atrial Fibrillation - complications</topic><topic>Atrial Fibrillation - diagnosis</topic><topic>Cardiac arrhythmia</topic><topic>Electrocardiography - adverse effects</topic><topic>Embolic Stroke - complications</topic><topic>Female</topic><topic>Fibrillation</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neurology</topic><topic>Neuroradiology</topic><topic>Neurosciences</topic><topic>Neurosurgery</topic><topic>Original Article</topic><topic>Psychiatry</topic><topic>Risk Factors</topic><topic>Stroke</topic><topic>Stroke - complications</topic><topic>Stroke - diagnosis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Del Monte, Alvise</creatorcontrib><creatorcontrib>Rivezzi, Francesco</creatorcontrib><creatorcontrib>Giacomin, Enrico</creatorcontrib><creatorcontrib>Peruzza, Francesco</creatorcontrib><creatorcontrib>Del Greco, Maurizio</creatorcontrib><creatorcontrib>Maines, Massimiliano</creatorcontrib><creatorcontrib>Migliore, Federico</creatorcontrib><creatorcontrib>Zorzi, Alessandro</creatorcontrib><creatorcontrib>Viaro, Federica</creatorcontrib><creatorcontrib>Pieroni, Alessio</creatorcontrib><creatorcontrib>La Licata, Andrea</creatorcontrib><creatorcontrib>Baracchini, Claudio</creatorcontrib><creatorcontrib>Bertaglia, Emanuele</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medicine (ProQuest)</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Consumer Health Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Family Health Database (ProQuest)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Psychology Database (ProQuest)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Neurological sciences</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Del Monte, Alvise</au><au>Rivezzi, Francesco</au><au>Giacomin, Enrico</au><au>Peruzza, Francesco</au><au>Del Greco, Maurizio</au><au>Maines, Massimiliano</au><au>Migliore, Federico</au><au>Zorzi, Alessandro</au><au>Viaro, Federica</au><au>Pieroni, Alessio</au><au>La Licata, Andrea</au><au>Baracchini, Claudio</au><au>Bertaglia, Emanuele</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Multiparametric identification of subclinical atrial fibrillation after an embolic stroke of undetermined source</atitle><jtitle>Neurological sciences</jtitle><stitle>Neurol Sci</stitle><addtitle>Neurol Sci</addtitle><date>2023-03-01</date><risdate>2023</risdate><volume>44</volume><issue>3</issue><spage>979</spage><epage>988</epage><pages>979-988</pages><issn>1590-1874</issn><eissn>1590-3478</eissn><abstract>Background
Subclinical atrial fibrillation (SCAF) may represent a cause of embolic stroke of undetermined source (ESUS) and its detection has important implications for secondary prevention with anticoagulation. Indications to implantable cardiac monitors (ICM) include SCAF detection. The aims of this study were to (1) evaluate the frequency of ICM-detected SCAF; (2) determine predictors of SCAF; and (3) identify patients who would benefit most from ICM implantation.
Methods
Between February 2017 and November 2020, all consecutive patients referred for ICM implantation after a diagnosis of ESUS and without previous history of atrial fibrillation or atrial flutter were included in this study. SCAF was diagnosed if the ICM electrogram demonstrated an episode of irregularly irregular rhythm without distinct P waves lasting > 2 min.
Results
We enrolled 109 patients (age 66, SD = 13 years; 36% females). During a median follow-up of 19.2 (IQR 11.0–27.5) months, SCAF episodes were detected in 36 (33%) patients. Only abnormal P wave terminal force in lead V1, left atrial end-systolic indexed volume > 34 ml/m
2
, and BMI > 25 kg/m
2
were independently associated with an increased risk of SCAF (HR 2.44, 95% CI 1.14–5.21,
p
= 0.021; HR 2.39, 95% CI 1.11–5.13,
p
= 0.026; and HR 2.64, 95% CI 1.06–6.49,
p
= 0.036 respectively). The ROC curve showed that the presence of all three parameters had the best accuracy (74%) to predict SCAF detection (sensitivity 39%, specificity 91%).
Conclusion
A multiparametric evaluation has the best accuracy to predict SCAF in ESUS patients and may help identifying those who would benefit most from ICM.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>36383264</pmid><doi>10.1007/s10072-022-06501-1</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-3878-2904</orcidid></addata></record> |
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| ispartof | Neurological sciences, 2023-03, Vol.44 (3), p.979-988 |
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| source | MEDLINE; SpringerLink |
| subjects | Aged Atrial Fibrillation - complications Atrial Fibrillation - diagnosis Cardiac arrhythmia Electrocardiography - adverse effects Embolic Stroke - complications Female Fibrillation Humans Male Medicine Medicine & Public Health Neurology Neuroradiology Neurosciences Neurosurgery Original Article Psychiatry Risk Factors Stroke Stroke - complications Stroke - diagnosis |
| title | Multiparametric identification of subclinical atrial fibrillation after an embolic stroke of undetermined source |
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