Abstract
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
Key Words
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Article info
Publication history
Published online: October 21, 2021
Accepted:
October 1,
2021
Received in revised form:
September 28,
2021
Received:
July 29,
2021
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106161
Copyright
© 2021 Elsevier Inc. All rights reserved.