Related Experiment Video
Updated: Oct 15, 2025
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
A Comprehensive Model to Predict Atrial Fibrillation in Cryptogenic Stroke: The Decryptoring Score
Alberto Vera1, Alberto Cecconi1, Álvaro Ximénez-Carrillo2
1Cardiology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid. IIS-IP, CIBER-CV, Madrid, Spain.
Insights
A new Decryptoring score accurately predicts atrial fibrillation (AF) in cryptogenic stroke (CS) patients. This tool aids in selecting secondary prevention strategies for cryptogenic stroke, improving patient outcomes.
Area of Science:
- Cardiology
- Neurology
- Medical Diagnostics
Background:
- Cryptogenic stroke (CS) accounts for up to 30% of ischemic strokes (IS).
- Atrial fibrillation (AF) is detected in up to 30% of CS cases, necessitating effective detection methods for secondary prevention.
- Current diagnostic tools lack comprehensive predictive capabilities for AF in CS.
Purpose of the Study:
- To develop and validate the Decryptoring score, a novel predictive tool for AF detection in patients with CS.
- To integrate clinical conditions, biomarkers, and left atrial strain (LAS) into a single predictive score.
- To guide secondary prevention strategies in cryptogenic stroke patients.
Main Methods:
- Prospective recruitment of 63 patients with IS or transient ischemic attack (TIA) and ABCD2 score ≥ 4.
- Collection of clinical, laboratory, and echocardiographic data, including LAS.
- 15-day wearable Holter-ECG monitoring for AF detection.
- Development of the Decryptoring score using univariate and multivariant analyses.
Main Results:
- Atrial fibrillation was detected in 24% of patients.
- Key predictors for AF included age > 75, hypertension, elevated Troponin T and NTproBNP, and reduced LAS reservoir and conductivity.
- The Decryptoring score demonstrated high predictive accuracy (AUC 0.94), significantly outperforming the AF-ESUS score (AUC 0.65).
- Patients with scores < 10 had 0% AF detection, while those with scores > 35 had 80% AF detection.
Conclusions:
- The novel Decryptoring score accurately predicts AF in patients with cryptogenic stroke.
- This score has the potential to guide secondary prevention strategies.
- Further validation in an independent cohort is required before clinical implementation.
Objetive:
Cryptogenic stroke (CS) represents up to 30% of ischemic strokes (IS). Since atrial fibrillation (AF) can be detected in up to 30% of CS, there is a clinical need for estimating the probability of underlying AF in CS to guide the optimal secondary prevention strategy. The aim of the study was to develop the first comprehensive predictive score including clinical conditions, biomarkers, and left atrial strain (LAS), to predict AF detection in this setting.
Methods:
Sixty-three consecutive patients with IS or transient ischemic attack with ABCD2 scale ≥ 4 of unknown etiology were prospectively recruited. Clinical, laboratory, and echocardiographic variables were collected. All patients underwent 15 days wearable Holter-ECG monitoring. Main objective was the Decryptoring score creation to predict AF in CS. Score variables were selected by a univariate analysis and, thereafter, score points were derived according to a multivariant analysis.
Results:
AF was detected in 15 patients (24%). Age > 75 (9 points), hypertension (1 point), Troponin T > 40 ng/L (8.5 points), NTproBNP > 200 pg/ml (0.5 points), LAS reservoir < 25.3% (24.5 points) and LAS conduct < 10.4% (0.5 points) were included in the score. The rate of AF detection was 0% among patients with a score of < 10 and 80% among patients with a score > 35. The comparison of the predictive validity between the proposed score and AF-ESUS score resulted in an AUC of 0.94 for Decryptoring score and of 0.65 for the AF-ESUS score(p < 0.001).
Conclusion:
This novel score offers an accurate AF prediction in patients with CS; however these results will require validation in an independent cohort using this model before they may be translated into clinical practice.
More Related Videos
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:30Acute Coronary Syndrome III: Diagnostic Studies