The presence of at least one cortical infarct on baseline MRI in patients with cryptogenic stroke or TIA significantly predicted the detection of paroxysmal atrial fibrillation on telemetry (OR 5.2).
Observational (n=132)
Yes
Do baseline MRI and echocardiographic characteristics predict the detection of paroxysmal atrial fibrillation on mobile cardiac telemetry in patients with cryptogenic ischemic stroke or TIA?
In patients with cryptogenic stroke or TIA, the presence of cortical infarcts on MRI and specific echocardiographic parameters (like LAVI/a' ratio) can help predict who will subsequently be diagnosed with paroxysmal atrial fibrillation on outpatient telemetry.
Effect estimate: OR 5.2 (95% CI 1.3-19)
p-value: p=.01
Background and Purpose: The objective of our study was to evaluate magnetic resonance imaging (MRI) and echocardiographic characteristics that would identify patients with cryptogenic ischemic stroke (IS) and transient ischemic attack (TIA) who subsequently developed paroxysmal atrial fibrillation (PAF) on mobile cardiac outpatient telemetry (MCOT). Methods: All patients with cryptogenic IS or TIA seen at the Emory University Hospital and Emory University Hospital Midtown from January 1, 2009, to June 30, 2013, who underwent MCOT were included in this analysis. Location (cortical, high subcortical, or neither) of current and prior strokes on MRI and left atrial (LA) functional and anatomical echocardiographic parameters were evaluated to determine their association with subsequent detection of PAF. Results: Of 132 patients, 17 (13%) had evidence of newly diagnosed PAF on MCOT (mean duration of monitoring = 25 days). The presence (vs absence) of ≥1 cortical infarct on baseline MRI was a significant predictor of identifying PAF (odds ratio: 5.2, 95% confidence interval: 1.3-19; P = .01). On baseline echocardiography, patients who had PAF (vs non-PAF) had significantly higher mean LA diameters (4.2 vs 3.7 cm, P = .03) and lower tissue Doppler velocity (a’; 5.5 vs 13.5 cm/s, P = .03). In receiver operating characteristic analysis, the ratio of LA volume index to the septal Doppler velocity (LAVI/a’) of >4.6 was associated with a higher likelihood of PAF. Combining MRI with echocardiographic variables did not improve the predictive ability beyond echocardiography alone. Conclusion: Although the presence of cortical-based infarcts on MRI in patients with cryptogenic IS or TIA increases the likelihood of detecting PAF on MCOT, LA functional and anatomic parameters alone best predicted which patients subsequently had PAF.
Kass‐Hout et al. (Mon,) conducted a observational in Cryptogenic ischemic stroke and transient ischemic attack (TIA) (n=132). Presence of ≥1 cortical infarct on baseline MRI vs. Absence of cortical infarct was evaluated on Detection of newly diagnosed paroxysmal atrial fibrillation (PAF) on mobile cardiac outpatient telemetry (OR 5.2, 95% CI 1.3-19, p=.01). The presence of at least one cortical infarct on baseline MRI in patients with cryptogenic stroke or TIA significantly predicted the detection of paroxysmal atrial fibrillation on telemetry (OR 5.2).