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Published on: February 26, 2013
Clinical and Biomarker Determinants for Recurrent Stroke in Patients With Atrial Fibrillation: A Systematic Review
Yuen Cheung1, Marianne Foley1, David Bradley1
1From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (Y.C., M.F., D.B., T.C., R.C., S.C., E.D., S.G., M.O.C., M.J.O.D., P.S., D.W., P.J.K., J.J.M.); Neurovascular Unit for Applied Translational and Therapeutics Research (Y.C., M.F., S.G., P.S., P.J.K., J.J.M.), Catherine McAuley Centre; School of Medicine (Y.C., M.F., T.C., S.G., P.S., P.J.K., J.J.M.), University College Dublin; Stroke Service (Y.C., M.F., S.G., P.S., J.J.M.), Department of Geriatric Medicine, Mater Misericordiae University Hospital; School of Medicine (D.B., R.C.), Trinity College Dublin; Department of Neurology (D.B.), St James Hospital; Department of Geriatric Medicine (T.C.), St Vincent's University Hospital; Stroke Service (R.C.), Department of Geriatric Medicine, Tallaght University Hospital, Dublin; Department of Neurology (S.C.), Cork University Hospital; Clinical Neurosciences (S.C.), School of Medicine, University College Cork; Stroke Service (E.D.), Department of Geriatric Medicine, James Connolly Memorial Hospital, Dublin, Ireland; Department of Clinical Neurosciences (K.K., I.I.), University of Cambridge, Addenbrooke's Hospital, United Kingdom; Department of Neurology & Stroke Centre (M.K., A.Z.), University Hospital Basel, Switzerland; Department of Geriatric Medicine (M.O.C.), Limerick University Hospital; College of Medicine (M.J.O.D.), Nursing and Health Sciences, University of Galway and University Hospital Galway; Department of Geriatric and Stroke Medicine (D.W.), RCSI University of Medicine and Health Sciences; Department of Geriatric Medicine (D.W.), and Department of Geriatric and Stroke Medicine (D.W.), Beaumont Hospital; and Stroke Service (P.J.K.), Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland.
Recurrent stroke risk in atrial fibrillation (AF) patients is high despite oral anticoagulants. This review identifies clinical factors and biomarkers, including AF burden and stroke despite treatment, to improve risk prediction and prevention strategies.
Area of Science:
- Cardiology and Neurology
- Stroke Medicine
- Biomarker Discovery
Background:
- Atrial fibrillation (AF) patients face a substantial risk of recurrent stroke (RS) annually (3.2%-6.5%), even with oral anticoagulant (OAC) therapy.
- The underlying reasons for this high residual risk remain unclear, necessitating improved risk prediction tools and novel therapeutic targets for secondary prevention.
Purpose of the Study:
- To systematically review and investigate the association of clinical factors, echocardiographic, blood, and neuroimaging biomarkers with recurrent stroke (RS) in patients with AF-related stroke.
Main Methods:
- A systematic literature search was conducted in Embase and Ovid Medline up to August 2023, including studies regardless of OAC use.
- Risk ratios (RRs) were pooled using random-effects models, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
- Included were 28 studies comprising 52,798 patients with 5,046 RS events.
Main Results:
- Clinical factors associated with RS included stroke despite OAC, sustained AF, hyperlipidemia, chronic kidney disease, and malignancy. NIH Stroke Scale scores and Asian ethnicity were linked to reduced risk.
- Neuroimaging markers like chronic lacunar infarcts, embolic-appearing infarcts, and cerebral microbleeds were associated with RS.
- Echocardiographic markers such as increased atrial size, intracardiac thrombus, spontaneous left atrial appendage (LAA) contrast, and low LAA intensity variation also correlated with RS.
Conclusions:
- AF burden and experiencing stroke despite OAC are clinically relevant factors for recurrence after AF-related stroke.
- Biomarkers indicating atrial cardiopathy, small vessel disease, and prior infarction are associated with RS.
- Collaborative efforts are crucial for identifying and validating novel risk factors and biomarkers for RS in AF patients.
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