Predicting Atrial Fibrillation with High Risk of Embolization with Atrial Strain and NT-proBNP
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ORIGINAL ARTICLE
Predicting Atrial Fibrillation with High Risk of Embolization with Atrial Strain and NT-proBNP Jorge Pagola 1 & Jesus Juega 1 & Jaume Francisco-Pascual 2 & Alejandro Bustamante 3 & Anna Penalba 3 & Elena Pala 3 & Maite Rodriguez 1 & Mercedes De Lera-Alfonso 4 & Juan F. Arenillas 4 & Juan Antonio Cabezas 5 & Francisco Moniche 5 & Reyes de Torres 5 & Joan Montaner 5 & Teresa González-Alujas 6 & Jose Alvarez-Sabin 1 & Carlos A. Molina 1 & on behalf of the Crypto-AF study group Received: 12 September 2020 / Revised: 6 October 2020 / Accepted: 26 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The aim of the study was to determine markers of atrial dysfunction in patients with cryptogenic stroke to predict episodes of paroxysmal atrial fibrillation with high risk of embolization (HpAF). We classified patients included in the Crypto-AF study, Cryptogenic Stroke registry, to detect paroxysmal atrial fibrillation (pAF) with wearable Holter, according to the longest episode of pAF in three groups: without pAF detection, episodes of pAF shorter than 5 h, and episodes of pAF longer than 5 h (HpAF). Atrial dysfunction surrogates were evaluated: EKG pattern, Holter record and echocardiography parameters (left atria volume (LAVI), and peak atrial longitudinal and contraction strain (PALS and PACS). The level of N-terminal pro b-type natriuretic peptide (NT-proBNP) was determined. All patients were followed for 2 years to detect pAF and stroke recurrence. From 308 patients, 253 patients with high quality Holter analysis were selected. The distribution was No pAF 78.6% (n = 199), pAF < 5 h 7.9% (n = 20), and HpAF > 5 h 13.4% (n = 34). Age of the patients and combination of PALS and NT-proBNP independently predicted HpAF OR 1.07 (1.00; 1.15) and OR 3.05 (1.08; 8.60) respectively. The validity of PALS and NT-proBNP to detect patients at risk of HpAF was higher than the validity of age (AUC 0.82, sensitivity 78.95%, specificity 63%). Patients with PALS < 25% and NT-proBNP > 283 pg/ml had more detection of pAF during follow-up 35% vs. 5.1% OR 2.33 (1.05–5.13) (p < 0.001). Multimodal assessment of atrial dysfunction with PALS and NT-proBNP improved the prediction of pAF episodes with high embolic risk in patients with cryptogenic stroke. Keywords Atrial fibrillation . Stroke . Cryptogenic stroke . Left atrial strain . NT-proBNP
* Jorge Pagola [email protected] 1
Stroke Unit, Medicine Department, Vall d’Hebrón Hospital and Autonomous University of Barcelona, Passeig Vall d’Hebrón, 119-129, 08035 Barcelona, Spain
2
Arrhythmia Unit-Cardiology Department, CIBER-CV, Valld’Hebrón Hospital, Barcelona, Spain
3
Neurovascular Research Lab, Valld’Hebrón Research Institute, Barcelona, Spain
4
Stroke Unit, University Hospital of Valladolid, Valladolid, Spain
5
Stroke Unit, University Hospitals Virgen Macarena-Virgen del Rocio, Seville, Spain
6
Echocardiography Lab Cardiology Department, Valld’Hebrón Hospital, Barcelona, Spain
Abbreviations HpAF Paroxysmal atrial fibrillati
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