Key result
The presence of chronic brain infarctions was associated with a higher rate of atrial fibrillation detection at 12 months in patients with cryptogenic stroke (15.8% vs 7.0%, HR 2.84, p=0.02).
Why the study?
Does acute brain infarction topography predict the detection of underlying atrial fibrillation using an insertable cardiac monitor in patients with cryptogenic stroke?
Observational (n=212)
Single-blind
Does acute brain infarction topography predict the detection of underlying atrial fibrillation using an insertable cardiac monitor in patients with cryptogenic stroke?
Acute brain infarct topography does not reliably predict underlying AF in cryptogenic stroke patients and should not be used to select patients for insertable cardiac monitors, though chronic infarcts and leukoaraiosis are associated with higher AF detection.
Answers are grounded in this paper and cite their sources.
Chronic brain infarctions may identify higher AF risk in cryptogenic stroke; leaves open whether imaging should guide monitoring decisions.
BACKGROUND: Insertable cardiac monitors (ICM) have been shown to detect atrial fibrillation (AF) at a higher rate than routine monitoring methods in patients with cryptogenic stroke (CS). However, it is unknown whether there are topographic patterns of brain infarction in patients with CS that are particularly associated with underlying AF. If such patterns exist, these could be used to help decide whether or not CS patients would benefit from long-term monitoring with an ICM. METHODS: In this retrospective analysis, a neuro-radiologist blinded to clinical details reviewed brain images from 212 patients with CS who were enrolled in the ICM arm of the CRYptogenic STroke And underLying AF (CRYSTAL AF) trial. Kaplan-Meier estimates were used to describe rates of AF detection at 12 months in patients with and without pre-specified imaging characteristics. Hazard ratios (HRs), 95% confidence intervals (CIs), and p values were calculated using Cox regression. RESULTS: We did not find any pattern of acute brain infarction that was significantly associated with AF detection after CS. However, the presence of chronic brain infarctions (15.8 vs. 7.0%, HR 2.84, 95% CI 1.13-7.15, p = 0.02) or leukoaraiosis (18.2 vs. 7.9%, HR 2.94, 95% CI 1.28-6.71, p < 0.01) was associated with AF detection. There was a borderline significant association of AF detection with the presence of chronic territorial (defined as within the territory of a first or second degree branch of the circle of Willis) infarcts (20.9 vs. 10.0%, HR 2.37, 95% CI 0.98-5.72, p = 0.05). CONCLUSIONS: We found no evidence for an association between brain infarction pattern and AF detection using an ICM in patients with CS, although patients with coexisting chronic, as well as acute, brain infarcts had a higher rate of AF detection. Acute brain infarction topography does not reliably predict or exclude detection of underlying AF in patients with CS and should not be used to select patients for ICM after cryptogenic stroke.
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Bernstein et al. (2015) conducted an observational in Cryptogenic stroke (n=212). Chronic brain infarctions vs. Absence of chronic brain infarctions was evaluated on Atrial fibrillation detection at 12 months (HR 2.84, 95% CI 1.13-7.15, p=0.02). The presence of chronic brain infarctions was associated with a higher rate of atrial fibrillation detection at 12 months in patients with cryptogenic stroke (15.8% vs 7.0%, HR 2.84, p=0.02).
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