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The Role of Electrocardiographic Markers for Predicting Atrial Fibrillation in Patients with Acute Ischemic Stroke: Data from the BIOSIGNAL Cohort Study

Background and Aims: P-wave abnormalities in the 12-lead electrocardiogram (ECG) have been associated with a higher risk of acute ischemic stroke (AIS) as well as atrial fibrillation (AF). This study aimed to assess pre-determined ECG criteria during sinus rhythm in unselected AIS patients and their...

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Autores principales: Schütz, Valerie, Dougoud, Svetlana, Bracher, Katja, Arnold, Markus, Schweizer, Juliane, Nakas, Christos, Westphal, Laura P., Inauen, Corinne, Pokorny, Thomas, Duru, Firat, Steffel, Jan, Luft, Andreas, Spanaus, Katharina, Saguner, Ardan Muammer, Katan, Mira
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10649302/
https://www.ncbi.nlm.nih.gov/pubmed/37959294
http://dx.doi.org/10.3390/jcm12216830
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author Schütz, Valerie
Dougoud, Svetlana
Bracher, Katja
Arnold, Markus
Schweizer, Juliane
Nakas, Christos
Westphal, Laura P.
Inauen, Corinne
Pokorny, Thomas
Duru, Firat
Steffel, Jan
Luft, Andreas
Spanaus, Katharina
Saguner, Ardan Muammer
Katan, Mira
author_facet Schütz, Valerie
Dougoud, Svetlana
Bracher, Katja
Arnold, Markus
Schweizer, Juliane
Nakas, Christos
Westphal, Laura P.
Inauen, Corinne
Pokorny, Thomas
Duru, Firat
Steffel, Jan
Luft, Andreas
Spanaus, Katharina
Saguner, Ardan Muammer
Katan, Mira
author_sort Schütz, Valerie
collection PubMed
description Background and Aims: P-wave abnormalities in the 12-lead electrocardiogram (ECG) have been associated with a higher risk of acute ischemic stroke (AIS) as well as atrial fibrillation (AF). This study aimed to assess pre-determined ECG criteria during sinus rhythm in unselected AIS patients and their value for predicting newly diagnosed atrial fibrillation (NDAF) after hospital admission. Methods: P-wave alterations were measured on 12-lead ECG on admission in all consecutively enrolled patients without known AF between October 2014 and 2017. The outcome of interest was NDAF, identified by prolonged electrocardiographic monitoring within one year after the index AIS. Univariable and multivariable logistic regression was applied to assess the magnitude and independence of the association between pre-selected ECG markers and NDAF. The discriminatory accuracy was evaluated with the area under the receiver operating characteristic curve (AUC), and the incremental prognostic value was estimated with the net reclassification index. Results: NDAF was detected in 87 (10%) of 856 patients during a follow-up of 365 days. Out of the pre-selected ECG parameters, advanced interatrial block (aIAB) and PR interval in lead II were independently associated with NDAF in univariable regression analysis. Only aIAB remained a significant predictor in multivariable analysis. Adding aIAB to the best-performing multivariable regression model improved the discriminatory accuracy to predict NDAF from an AUC of 0.78 (95%-CI 0.77–0.80) to 0.81 (95%-CI 0.80–0.83, p < 0.001). Conclusion: aIAB is independently and highly associated with NDAF in patients with AIS, has high inter-rater reliability, and therefore may be helpful to refine diagnostic work-up to search for AF in AIS.
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spelling pubmed-106493022023-10-29 The Role of Electrocardiographic Markers for Predicting Atrial Fibrillation in Patients with Acute Ischemic Stroke: Data from the BIOSIGNAL Cohort Study Schütz, Valerie Dougoud, Svetlana Bracher, Katja Arnold, Markus Schweizer, Juliane Nakas, Christos Westphal, Laura P. Inauen, Corinne Pokorny, Thomas Duru, Firat Steffel, Jan Luft, Andreas Spanaus, Katharina Saguner, Ardan Muammer Katan, Mira J Clin Med Article Background and Aims: P-wave abnormalities in the 12-lead electrocardiogram (ECG) have been associated with a higher risk of acute ischemic stroke (AIS) as well as atrial fibrillation (AF). This study aimed to assess pre-determined ECG criteria during sinus rhythm in unselected AIS patients and their value for predicting newly diagnosed atrial fibrillation (NDAF) after hospital admission. Methods: P-wave alterations were measured on 12-lead ECG on admission in all consecutively enrolled patients without known AF between October 2014 and 2017. The outcome of interest was NDAF, identified by prolonged electrocardiographic monitoring within one year after the index AIS. Univariable and multivariable logistic regression was applied to assess the magnitude and independence of the association between pre-selected ECG markers and NDAF. The discriminatory accuracy was evaluated with the area under the receiver operating characteristic curve (AUC), and the incremental prognostic value was estimated with the net reclassification index. Results: NDAF was detected in 87 (10%) of 856 patients during a follow-up of 365 days. Out of the pre-selected ECG parameters, advanced interatrial block (aIAB) and PR interval in lead II were independently associated with NDAF in univariable regression analysis. Only aIAB remained a significant predictor in multivariable analysis. Adding aIAB to the best-performing multivariable regression model improved the discriminatory accuracy to predict NDAF from an AUC of 0.78 (95%-CI 0.77–0.80) to 0.81 (95%-CI 0.80–0.83, p < 0.001). Conclusion: aIAB is independently and highly associated with NDAF in patients with AIS, has high inter-rater reliability, and therefore may be helpful to refine diagnostic work-up to search for AF in AIS. MDPI 2023-10-29 /pmc/articles/PMC10649302/ /pubmed/37959294 http://dx.doi.org/10.3390/jcm12216830 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Schütz, Valerie
Dougoud, Svetlana
Bracher, Katja
Arnold, Markus
Schweizer, Juliane
Nakas, Christos
Westphal, Laura P.
Inauen, Corinne
Pokorny, Thomas
Duru, Firat
Steffel, Jan
Luft, Andreas
Spanaus, Katharina
Saguner, Ardan Muammer
Katan, Mira
The Role of Electrocardiographic Markers for Predicting Atrial Fibrillation in Patients with Acute Ischemic Stroke: Data from the BIOSIGNAL Cohort Study
title The Role of Electrocardiographic Markers for Predicting Atrial Fibrillation in Patients with Acute Ischemic Stroke: Data from the BIOSIGNAL Cohort Study
title_full The Role of Electrocardiographic Markers for Predicting Atrial Fibrillation in Patients with Acute Ischemic Stroke: Data from the BIOSIGNAL Cohort Study
title_fullStr The Role of Electrocardiographic Markers for Predicting Atrial Fibrillation in Patients with Acute Ischemic Stroke: Data from the BIOSIGNAL Cohort Study
title_full_unstemmed The Role of Electrocardiographic Markers for Predicting Atrial Fibrillation in Patients with Acute Ischemic Stroke: Data from the BIOSIGNAL Cohort Study
title_short The Role of Electrocardiographic Markers for Predicting Atrial Fibrillation in Patients with Acute Ischemic Stroke: Data from the BIOSIGNAL Cohort Study
title_sort role of electrocardiographic markers for predicting atrial fibrillation in patients with acute ischemic stroke: data from the biosignal cohort study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10649302/
https://www.ncbi.nlm.nih.gov/pubmed/37959294
http://dx.doi.org/10.3390/jcm12216830
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