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Atrial cardiopathy predicts detection of atrial fibrillation in embolic stroke of undetermined source: real-life data

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Abstract

Objectives

Atrial cardiopathy (AC) is more frequent in patients with embolic stroke of undetermined source (ESUS) than in patients with non-cardioembolic stroke. The aim of this work was to describe AC in patients with ESUS and to study its impact on detection of atrial fibrillation (AF) during follow-up.

Methods

This is an observational study of 123 consecutive ESUS patients and 55 ESUS patients from a previous cohort. AC was defined according to the presence of one or more of the following criteria: severe left atrial enlargement, p-wave terminal force in lead V1 > 5000 μVxms, and excessive premature atrial complexes. Unadjusted and adjusted survival analyses for the occurrence of AF and stroke or transient ischemic attack (TIA) were performed. Diagnostic performance of AC for the detection of AF was analyzed.

Results

Among 178 patients with ESUS, those with AC (42.7%) were older (p < 0.001), and more frequently had hypertension (p = 0.001) and lower total cholesterol levels (p = 0.001) than patients without AC. The detection of AF during follow-up (median 34 months, interquartile range = 12.8–64) was higher in patients with AC (hazard ratio = 7.00, 95% confidence interval = 2.01–24.39, p = 0.002). This association persisted after adjusting for age, arterial hypertension, and other vascular risk factors. The c-statistic for detection of AF during follow-up for AC was 0.719. There were no differences in stroke or TIA recurrence between groups with and without AC.

Discussion

ESUS patients with AC have different baseline clinical characteristics than patients without AC and have a higher detection of AF during follow-up.

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Availability of data and material

The data supporting the findings of this study are available upon reasonable request.

Code availability

Not applicable.

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Authors and Affiliations

  1. Department of Neurology, Hospital de Braga, Braga, Portugal

    Ana Rita Silva, Filipa Meira-Carvalho, José Nuno Alves & Carla Ferreira

  2. Department of Cardiology, Hospital de Braga, Braga, Portugal

    Carla Pires & Nuno Pimenta Antunes

  3. Department of Neuroradiology, Hospital de Braga, Braga, Portugal

    Mariana Santos

  4. Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany

    João Pinho

Authors
  1. Ana Rita Silva
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  2. Carla Pires
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  3. Filipa Meira-Carvalho
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  4. Mariana Santos
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  5. Nuno Pimenta Antunes
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  6. José Nuno Alves
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  7. Carla Ferreira
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  8. João Pinho
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Corresponding author

Correspondence to Ana Rita Silva.

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Ethical approval

The study was approved by the local health ethics committee (ref. 40/2019).

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Silva, A.R., Pires, C., Meira-Carvalho, F. et al. Atrial cardiopathy predicts detection of atrial fibrillation in embolic stroke of undetermined source: real-life data. Neurol Sci 43, 2383–2386 (2022). https://doi.org/10.1007/s10072-021-05692-3

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  • DOI: https://doi.org/10.1007/s10072-021-05692-3

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