Prospective multicentric validation of a novel prediction model for paroxysmal atrial fibrillation
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ORIGINAL PAPER
Prospective multicentric validation of a novel prediction model for paroxysmal atrial fibrillation Constanze Schmidt1,2 · Sebastian Benda1,2 · Patricia Kraft3 · Felix Wiedmann1,2 · Sven Pleger1,3 · Antonius Büscher1,2 · Dierk Thomas1,2 · Rolf Wachter4,5 · Christian Schmid6 · Roland Eils7,8 · Hugo A. Katus1,2 · Stefan M. Kallenberger7,8 Received: 15 August 2020 / Accepted: 27 October 2020 © The Author(s) 2020
Abstract Background The early recognition of paroxysmal atrial fibrillation (pAF) is a major clinical challenge for preventing thromboembolic events. In this prospective and multicentric study we evaluated prediction scores for the presence of pAF, calculated from non-invasive medical history and echocardiographic parameters, in patients with unknown AF status. Methods The 12-parameter score with parameters age, LA diameter, aortic root diameter, LV,ESD, TDI Aʹ, heart frequency, sleep apnea, hyperlipidemia, type II diabetes, smoker, ß-blocker, catheter ablation, and the 4-parameter score with parameters age, LA diameter, aortic root diameter and TDI A’ were tested. Presence of pAF was verified by continuous electrocardiogram (ECG) monitoring for up to 21 days in 305 patients. Results The 12-parameter score correctly predicted pAF in all 34 patients, in which pAF was newly detected by ECG monitoring. The 12- and 4-parameter scores showed sensitivities of 100% and 82% (95%-CI 65%, 93%), specificities of 75% (95%-CI 70%, 80%) and 67% (95%-CI 61%, 73%), and areas under the receiver operating characteristic (ROC) curves of 0.84 (95%-CI 0.80, 0.88) and 0.81 (95%-CI 0.74, 0.87). Furthermore, properties of AF episodes and durations of ECG monitoring necessary to detect pAF were analysed. Conclusions The prediction scores adequately detected pAF using variables readily available during routine cardiac assessment and echocardiography. The model scores, denoted as ECHO-AF scores, represent simple, highly sensitive and noninvasive tools for detecting pAF that can be easily implemented in the clinical practice and might serve as screening test to initiate further diagnostic investigations for validating the presence of pAF. Graphic abstract Prospective validation of a novel prediction model for paroxysmal atrial fibrillation based on echocardiography and medical history parameters by long-term Holter ECG
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00392-020-01773-z) contains supplementary material, which is available to authorized users. Extended author information available on the last page of the article
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Clinical Research in Cardiology
Keywords Paroxysmal atrial fibrillation · Atrial fibrillation detection · AF prediction model · ECHO-AF scores · Stroke prevention · Systems medicine
Introduction Atrial fibrillation (AF) is the most frequent arrhythmia but often remains unrecognized. Early detection is highly relevant to reducing stroke, heart failure and mortality but represents a major clinical challenge [1]. Deve
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