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Published on: July 20, 2022
Multimodal Approach for the Prediction of Atrial Fibrillation Detected After Stroke: SAFAS Study
Lucie Garnier1,2, Gauthier Duloquin1,2, Alexandre Meloux2
1Department of Neurology, University Hospital, Dijon, France.
Insights
Atrial fibrillation detected after stroke (AFDAS) is associated with specific biomarkers and cardiac structural changes. These findings suggest AFDAS may stem from an underlying atrial cardiopathy, aiding in stroke risk assessment.
Area of Science:
- Cardiology
- Neurology
- Biomarker Research
Background:
- Atrial fibrillation (AF) is a recognized cause of stroke.
- The pathophysiology and embolic risk of AF Detected After Stroke (AFDAS) remain debated compared to prior-to-stroke AF.
Purpose of the Study:
- To systematically investigate AFDAS using a multimodal approach.
- To identify clinical, imaging, biological, and electrocardiographic markers associated with AFDAS.
Main Methods:
- Prospective enrollment of acute ischemic stroke patients without known AF.
- Diagnosis of AFDAS at 6 months via ECG, continuous monitoring, Holter, or implantable cardiac monitor.
- Multivariable analysis to identify independent predictors of AFDAS.
Main Results:
- 32% of patients developed AFDAS.
- AFDAS patients were older, more often women, and less often smokers.
- Independent predictors included elevated NT-proBNP, osteoprotegerin, galectin-3, and increased left atrial indexed volume (LAVI).
Conclusions:
- A multimodal approach effectively predicts AFDAS.
- Findings suggest AFDAS is linked to an underlying atrial cardiopathy.
- Biomarkers and imaging markers aid in understanding AFDAS pathophysiology.
Background:
Intensive screening for atrial fibrillation (AF) has led to a better recognition of this cause in stroke patients. However, it is currently debated whether AF Detected After Stroke (AFDAS) has the same pathophysiology and embolic risk as prior-to-stroke AF. We thus aimed to systematically approach AFDAS using a multimodal approach combining clinical, imaging, biological and electrocardiographic markers.
Methods:
Patients without previously known AF admitted to the Dijon University Hospital (France) stroke unit for acute ischemic stroke were prospectively enrolled. The primary endpoint was the presence of AFDAS at 6 months, diagnosed through admission ECG, continuous electrocardiographic monitoring, long-term external Holter during the hospital stay, or implantable cardiac monitor if clinically indicated after discharge.
Results:
Of the 240 included patients, 77 (32%) developed AFDAS. Compared with sinus rhythm patients, those developing AFDAS were older, more often women and less often active smokers. AFDAS patients had higher blood levels of NT-proBNP, osteoprotegerin, galectin-3, GDF-15 and ST2, as well as increased left atrial indexed volume and lower left ventricular ejection fraction. After multivariable analysis, galectin-3 ≧ 9 ng/ml [OR 3.10; 95% CI (1.03-9.254), p = 0.042], NT-proBNP ≧ 290 pg/ml [OR 3.950; 95% CI (1.754-8.892, p = 0.001], OPG ≥ 887 pg/ml [OR 2.338; 95% CI (1.015-5.620), p = 0.046) and LAVI ≥ 33.5 ml/m2 [OR 2.982; 95% CI (1.342-6.625), p = 0.007] were independently associated with AFDAS.
Conclusion:
A multimodal approach combining imaging, electrocardiography and original biological markers resulted in good predictive models for AFDAS. These results also suggest that AFDAS is probably related to an underlying atrial cardiopathy.
Clinical Trial Registration:
[www.ClinicalTrials.gov], identifier [NCT03570060].
