Stroke risk analysis (SRA) predicted incident atrial fibrillation with 95% sensitivity and 96% negative predictive value compared to 20-month implantable cardiac monitoring in cryptogenic stroke.
Observational (n=105)
No
Does stroke risk analysis (SRA) accurately predict incident atrial fibrillation compared to implantable cardiac monitors in patients with cryptogenic stroke?
Stroke risk analysis (SRA) has a high negative predictive value for incident AF and may serve as a cost-effective pre-selection tool for implantable cardiac monitoring in cryptogenic stroke patients.
BACKGROUND AND PURPOSE: Detection of occult atrial fibrillation (AF) is crucial for optimal secondary prevention in stroke patients. The AF detection rate was determined by implantable cardiac monitor (ICM) and compared to the prediction rate of the probability of incident AF by software based analysis of a continuously monitored electrocardiogram at follow-up (stroke risk analysis, SRA); an optimized AF detection algorithm is proposed by combining both tools. METHODS: In a monocentric prospective study 105 out of 389 patients with cryptogenic stroke despite extensive diagnostic workup were investigated with two additional cardiac monitoring tools: (a) 20 months' monitoring by ICM and (b) SRA during hospitalization at the stroke unit. RESULTS: The detection rate of occult AF was 18% by ICM (n = 19) (range 6-575 days) and 62% (n = 65) had an increased risk for AF predicted by SRA. When comparing the predictive accuracy of SRA to ICM, the sensitivity was 95%, specificity 35%, positive predictive value 27% and negative predictive value 96%. In 18 patients with AF detected by ICM, SRA also showed a medium risk for AF. Only one patient with a very low risk predicted by SRA developed AF revealed by ICM after 417 days. CONCLUSIONS: A combination of SRA and ICM is a promising strategy to detect occult AF. SRA is reliable in predicting incident AF with a high negative predictive value. Thus, SRA may serve as a cost-effective pre-selection tool identifying patients at risk for AF who may benefit from further cardiac monitoring by ICM.
Reinke et al. (Tue,) conducted a observational in Cryptogenic stroke (n=105). Stroke risk analysis (SRA) vs. Implantable cardiac monitor (ICM) was evaluated on Detection of occult atrial fibrillation. Stroke risk analysis (SRA) predicted incident atrial fibrillation with 95% sensitivity and 96% negative predictive value compared to 20-month implantable cardiac monitoring in cryptogenic stroke.