See editorial by Seet on page 1331.
Predictors of newly diagnosed atrial fibrillation in cryptogenic stroke: a cohort study
Article first published online: 4 NOV 2012
© 2012 The Author(s) European Journal of Neurology © 2012 EFNS
European Journal of Neurology
Volume 20, Issue 10, pages 1352–1359, October 2013
How to Cite
Bugnicourt, J.-M., Flament, M., Guillaumont, M.-P., Chillon, J.-M., Leclercq, C., Canaple, S., Lamy, C. and Godefroy, O. (2013), Predictors of newly diagnosed atrial fibrillation in cryptogenic stroke: a cohort study. European Journal of Neurology, 20: 1352–1359. doi: 10.1111/ene.12017
- Issue published online: 12 SEP 2013
- Article first published online: 4 NOV 2012
- Manuscript Accepted: 6 SEP 2012
- Manuscript Received: 7 JUN 2012
- atrial fibrillation;
- ischaemic stroke;
- secondary prevention
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.
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.
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 cm2 (two points) (total score ranging from 0 to 6). Patients with a score ≤1 point did not have NDAF during follow-up.
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.