Non-ECG predictors of atrial fibrillation in ischaemic stroke: A systematic review

Luke Bonavia; Alexander Berry‐Noronha; E. Song; Daniel Grose; Damian Johnson; Erin Maylin; Ramesh Sahathevan

doi:10.1016/j.hsr.2024.100161

March 12, 2024Health Sciences ReviewOpen Access

Non-ECG predictors of atrial fibrillation in ischaemic stroke: A systematic review

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Why the study?

Using novel biomarkers to predict future AF risk may aid decision-making regarding anticoagulant therapy for stroke prevention.

Does the assessment of non-ECG predictors (echocardiography, blood tests, imaging, anthropometry) predict the development of atrial fibrillation in patients with ischaemic stroke?

Structured PICO

Does the assessment of non-ECG predictors (echocardiography, blood tests, imaging, anthropometry) predict the development of atrial fibrillation in patients with ischaemic stroke?

P

Population

Patients with ischaemic stroke

I

Intervention

Assessment of non-ECG predictors including quantitative echocardiography, blood tests (BNP/NT-proBNP), imaging (stroke topology), and anthropometry (BMI, lean/fat mass)

O

Outcome

Development of atrial fibrillationhard clinical

Non-ECG biomarkers such as echocardiographic parameters, natriuretic peptides, anthropometry, and stroke topology are predictive of atrial fibrillation development in ischemic stroke patients.

Implication

Supports post-stroke AF surveillance with echo, biomarkers and anthropometrics; extends multimodal predictor evidence for risk stratification.

Abstract

The use of novel biomarkers to predict future atrial fibrillation (AF) risk may aid decision making with anti-coagulant therapy for stroke prevention. The purpose of our study was to determine whether quantitative echocardiography, blood tests, imaging, anthropometry are predictive of atrial fibrillation. Electrocardiography was not the scope of this review. Incremental increases in atrial volume and atrial diameter were most commonly associated with AF development. Likewise, incremental Brain Natriuretic Peptide (BNP) and N-terminal pro-(BNP) levels also correlate with AF risk. Anthropometric predictors such as BMI, lean mass and fat mass were also predictive of AF. Of studies reporting stroke topology, the presence of cortical infarcts, posterior circulation infarcts, multi-territory infarcts were independently predictive of AF. Newer echocardiographic techniques such as atrial and ventricular strain analysis were shown to be predictive of AF in multiple studies. Use of these biomarkers in composite scoring systems may accurately predict AF development and further help stratify patients that may benefit from anticoagulation for stroke prevention.