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Published on: February 26, 2013
Natural courses of atrial fibrillation following cryptogenic stroke: A systematic review and meta-analysis
Patavee Pajareya1, Somkiat Phutinart1, Noppachai Siranart1
1Division of Cardiovascular Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Insights
Atrial fibrillation detected after stroke (AFDAS) occurs in 20.8% of cryptogenic stroke patients, often linked to age and hypertension. Extended cardiac monitoring is recommended for early detection and improved patient outcomes.
Area of Science:
- Cardiology
- Neurology
- Epidemiology
Background:
- Cryptogenic stroke (CS) poses management challenges and increases recurrence risk.
- The clinical significance of atrial fibrillation detected after stroke (AFDAS) is not well-established.
- Identifying predictors and clinical characteristics of AFDAS is crucial for stroke management.
Purpose of the Study:
- To investigate the incidence of AFDAS in patients with CS.
- To identify predictors associated with AFDAS incidence.
- To compare clinical characteristics between patients with and without AFDAS following CS.
Main Methods:
- A meta-analysis of observational studies was performed.
- Random-effects models were utilized to synthesize data.
- Included studies focused on cryptogenic stroke patients and atrial fibrillation detection.
Main Results:
- The meta-analysis included 59 studies with 18,683 CS patients; AFDAS incidence was 20.8%.
- Predictors of AFDAS included age >75 years (OR 6.94) and hypertension (OR 2.16).
- AF patients exhibited higher left atrial volume, D-dimer, CHA2DS2-VASc score, and P-wave duration, but lower atrial strain parameters.
Conclusions:
- Certain comorbidities are linked to AFDAS, and detection is often delayed post-CS.
- Identified predictors and clinical differences warrant consideration for guideline updates.
- Enhanced cardiac monitoring strategies are recommended for CS patients to improve AF detection.
Background:
Cryptogenic stroke (CS) presents challenges in management and increases risk of stroke recurrence. The clinical relevance of atrial fibrillation detected after stroke (AFDAS) remains equivocal.
Methods:
Our study was conducted in a meta-analysis design, including all observational studies and utilizing random-effects model. The objectives were to explore the association between predictors and AFDAS incidence, and clinical differences between AF and non-AF patients following CS.
Results:
This meta-analysis included 59 studies with 18,683 patients with CS. AFDAS incidence was 20.8 %. In univariable analysis, significant predictors of AFDAS were age >75 years (OR 6.94, 95 % CI: 3.12-15.43, I2 = 0 %) and hypertension (OR 2.16, 95 % CI: 1.28-3.63, I2 = 0.0 %). In comparison to non-AF group, individuals with AF showed significantly higher levels of left atrial volume index (MD 7.50 mL/m2, 95 % CI: 6.20-8.80, I2 = 0.0 %), left atrial diameter (MD 0.17 cm, 95 % CI: 0.02-0.32, I2 = 48.6 %), D-dimer (MD 0.20 mg/L, 95 % CI: 0.05-0.36, I2 = 0.0 %), CHA2DS2VASc score (MD 0.76 point, 95 % CI: 0.53-0.98, I2 = 64.2 %), and P-wave duration (MD 9.49 ms, 95 % CI: 0.75-18.23, I2 = 30.4 %). Significantly lower levels were observed in left atrial contractile strain (MD -5.68 %, 95 % CI: 7.45 to -3.91, I2 = 58.0 %) and left atrial reservoir strain (MD -9.05 %, 95 % CI: 12.2 to -5.91, I2 = 71.9 %). The mean time from CS to AF detection was 162 days and from cardiac monitoring to AF detection was 49 days.
Conclusion:
Our study highlighted the potential link between certain comorbidities and demonstrated the delay in AF detection following CS. The significant parameters identified should be considered as new recommendations to the guideline for extended cardiac monitoring in CS patients. It is time to change the level of surveillance in this population.
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