Biomarkers of Atrial Cardiopathy and Atrial Fibrillation Detection on Mobile Outpatient Continuous Telemetry After Embolic Stroke of Undetermined Source

• Published in: Journal of stroke and cerebrovascular diseases 2017-06, Vol.26 (6), p.1249-1253
• Main Authors: Sebasigari, Denise, MD, Merkler, Alexander, MD, Guo, Yang, BS, Gialdini, Gino, MD, Kummer, Benjamin, MD, Hemendinger, Morgan, BS, Song, Christopher, MD, Chu, Antony, MD, Cutting, Shawna, MD, Silver, Brian, MD, Elkind, Mitchell S.V., MD, Kamel, Hooman, MD, Furie, Karen L., MD, Yaghi, Shadi, MD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Ambulatory Care - methods; atrial cardiopathy; atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - diagnosis; Atrial Fibrillation - physiopathology; Atrial Flutter - complications; Atrial Flutter - diagnosis; Atrial Flutter - physiopathology; Atrial Function, Right; Cardiovascular; Cryptogenic stroke; Echocardiography; Electrocardiography, Ambulatory; embolic stroke of undetermined source; Female; Heart Atria - diagnostic imaging; Heart Atria - physiopathology; Heart Rate; Humans; Intracranial Embolism - diagnosis; Intracranial Embolism - etiology; ischemic stroke; Logistic Models; Male; Middle Aged; Multivariate Analysis; Neurology; Odds Ratio; Predictive Value of Tests; Prognosis; Retrospective Studies; Risk Assessment; Risk Factors; Stroke - diagnosis; Stroke - etiology; Telemetry - methods; Ventricular Function, Left
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2017.01.016

Background Biomarkers of atrial dysfunction or “cardiopathy” are associated with embolic stroke risk. However, it is unclear if this risk is mediated by undiagnosed paroxysmal atrial fibrillation or flutter (AF). We aim to determine whether atrial cardiopathy biomarkers predict AF on continuous heart-rhythm monitoring after embolic stroke of undetermined source (ESUS). Methods This was a single-center retrospective study including all patients with ESUS undergoing 30 days of ambulatory heart-rhythm monitoring to look for AF between January 1, 2013 and December 31, 2015. We reviewed medical records for clinical, radiographic, and cardiac variables. The primary outcome was a new diagnosis of AF detected during heart-rhythm monitoring. The primary predictors were atrial biomarkers: left atrial diameter on echocardiography, P-wave terminal force in electrocardiogram (ECG) lead V1, and P wave - R wave (PR) interval on ECG. A multiple logistic regression model was used to assess the relationship between atrial biomarkers and AF detection. Results Among 196 eligible patients, 23 (11.7%) were diagnosed with AF. In unadjusted analyses, patients with AF were older (72.4 years versus 61.4 years, P