Factors associated with the detection of atrial fibrillation in patients with embolic stroke of undetermined source
Abstract Background Detection of atrial fibrillation (AF) in patients with embolic stroke of undetermined source (ESUS) is important for the secondary prevention of stroke. We investigated the factors associated with the detection of newly diagnosed AF in ESUS patients during follow-up. Methods Pati...
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2025-01-01
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| Online Access: | https://doi.org/10.1186/s12883-024-04008-0 |
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| author | Jae-Han Bae Jae-Chan Ryu Sang Hee Ha Min Soo Cho Myung-Jin Cha Jun Young Chang Dong-Wha Kang Sun U. Kwon Jong S. Kim Bum Joon Kim |
| author_facet | Jae-Han Bae Jae-Chan Ryu Sang Hee Ha Min Soo Cho Myung-Jin Cha Jun Young Chang Dong-Wha Kang Sun U. Kwon Jong S. Kim Bum Joon Kim |
| author_sort | Jae-Han Bae |
| collection | DOAJ |
| description | Abstract Background Detection of atrial fibrillation (AF) in patients with embolic stroke of undetermined source (ESUS) is important for the secondary prevention of stroke. We investigated the factors associated with the detection of newly diagnosed AF in ESUS patients during follow-up. Methods Patients with acute ischemic stroke classified as ESUS were included. All patients underwent transthoracic echocardiography and Holter to detect the source of embolism. Structural, electrophysiological markers of left atrial cardiopathy (i.e., left atrial enlargement [LAE], non-sustained tachycardia [NSAT]) as well as lesion patterns of ischemic stroke were examined. Implantable loop recorder (ILR) was implanted in selective patients. Sensitivity and positive predictive value analysis was used to assess the predictive value for AF detection. Results Among 312 patients with ESUS, AF was detected in 24 (7.7%) patients during follow-up. Patients with AF had a higher prevalence of LAE, NSAT, and the imaging pattern of confluent plus additional lesions in a single vascular territory. Multivariable analysis showed that ILR implantation (hazards ratio 11.497 [95% confidence interval 3.795–34.818]), LAE (3.204 [1.096–9.370]), NSAT (4.070 [1.378–12.018]), and confluent plus additional lesions (4.977 [1.649–15.019]) were independent predictors of AF detection. The sensitivity of detecting AF in those with LAE, NSAT, or confluent plus additional lesions pattern was 91.7%. The positive predictive value of detecting AF in those with LAE, NSAT and confluent plus additional lesions pattern was 40.0%. Conclusion In conclusion, patients with LAE, NSAT, or confluent plus additional lesions may benefit from ILR monitoring detecting new AF. |
| format | Article |
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| institution | Kabale University |
| issn | 1471-2377 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | BMC Neurology |
| spelling | doaj-art-d0b9da7eb6e74e7281752c6ca56d84db2025-01-12T12:28:42ZengBMCBMC Neurology1471-23772025-01-012511910.1186/s12883-024-04008-0Factors associated with the detection of atrial fibrillation in patients with embolic stroke of undetermined sourceJae-Han Bae0Jae-Chan Ryu1Sang Hee Ha2Min Soo Cho3Myung-Jin Cha4Jun Young Chang5Dong-Wha Kang6Sun U. Kwon7Jong S. Kim8Bum Joon Kim9Department of Neurology, Asan Medical Center, University of Ulsan College of MedicineDepartment of Neurology, Gimcheon Jeil HospitalDepartment of Neurology, Gil Medical Center, Gachon UniversityDepartment of Cardiology, Asan Medical Center, University of Ulsan College of MedicineDepartment of Cardiology, Asan Medical Center, University of Ulsan College of MedicineDepartment of Neurology, Asan Medical Center, University of Ulsan College of MedicineDepartment of Neurology, Asan Medical Center, University of Ulsan College of MedicineDepartment of Neurology, Asan Medical Center, University of Ulsan College of MedicineDepartment of Neurology, Gangneung Asan Hospital, University of Ulsan College of MedicineDepartment of Neurology, Asan Medical Center, University of Ulsan College of MedicineAbstract Background Detection of atrial fibrillation (AF) in patients with embolic stroke of undetermined source (ESUS) is important for the secondary prevention of stroke. We investigated the factors associated with the detection of newly diagnosed AF in ESUS patients during follow-up. Methods Patients with acute ischemic stroke classified as ESUS were included. All patients underwent transthoracic echocardiography and Holter to detect the source of embolism. Structural, electrophysiological markers of left atrial cardiopathy (i.e., left atrial enlargement [LAE], non-sustained tachycardia [NSAT]) as well as lesion patterns of ischemic stroke were examined. Implantable loop recorder (ILR) was implanted in selective patients. Sensitivity and positive predictive value analysis was used to assess the predictive value for AF detection. Results Among 312 patients with ESUS, AF was detected in 24 (7.7%) patients during follow-up. Patients with AF had a higher prevalence of LAE, NSAT, and the imaging pattern of confluent plus additional lesions in a single vascular territory. Multivariable analysis showed that ILR implantation (hazards ratio 11.497 [95% confidence interval 3.795–34.818]), LAE (3.204 [1.096–9.370]), NSAT (4.070 [1.378–12.018]), and confluent plus additional lesions (4.977 [1.649–15.019]) were independent predictors of AF detection. The sensitivity of detecting AF in those with LAE, NSAT, or confluent plus additional lesions pattern was 91.7%. The positive predictive value of detecting AF in those with LAE, NSAT and confluent plus additional lesions pattern was 40.0%. Conclusion In conclusion, patients with LAE, NSAT, or confluent plus additional lesions may benefit from ILR monitoring detecting new AF.https://doi.org/10.1186/s12883-024-04008-0ESUSImplantable loop recorderAtrial cardiopathyLeft atrial enlargement |
| spellingShingle | Jae-Han Bae Jae-Chan Ryu Sang Hee Ha Min Soo Cho Myung-Jin Cha Jun Young Chang Dong-Wha Kang Sun U. Kwon Jong S. Kim Bum Joon Kim Factors associated with the detection of atrial fibrillation in patients with embolic stroke of undetermined source BMC Neurology ESUS Implantable loop recorder Atrial cardiopathy Left atrial enlargement |
| title | Factors associated with the detection of atrial fibrillation in patients with embolic stroke of undetermined source |
| title_full | Factors associated with the detection of atrial fibrillation in patients with embolic stroke of undetermined source |
| title_fullStr | Factors associated with the detection of atrial fibrillation in patients with embolic stroke of undetermined source |
| title_full_unstemmed | Factors associated with the detection of atrial fibrillation in patients with embolic stroke of undetermined source |
| title_short | Factors associated with the detection of atrial fibrillation in patients with embolic stroke of undetermined source |
| title_sort | factors associated with the detection of atrial fibrillation in patients with embolic stroke of undetermined source |
| topic | ESUS Implantable loop recorder Atrial cardiopathy Left atrial enlargement |
| url | https://doi.org/10.1186/s12883-024-04008-0 |
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