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Potential Utility of Neurosonology in Paroxysmal Atrial Fibrillation Detection in Patients with Cryptogenic Stroke

Background: Occult paroxysmal atrial fibrillation (PAF) is a common and potential treatable cause of cryptogenic stroke (CS). We sought to prospectively identify independent predictors of atrial fibrillation (AF) detection in patients with CS and sinus rhythm on baseline electrocardiogram (ECG), wit...

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Autores principales: Liantinioti, Chrissoula, Palaiodimou, Lina, Tympas, Konstantinos, Parissis, John, Theodorou, Aikaterini, Ikonomidis, Ignatios, Chondrogianni, Maria, Zompola, Christina, Triantafyllou, Sokratis, Roussopoulou, Andromachi, Kargiotis, Odysseas, Serdari, Aspasia, Bonakis, Anastasios, Vadikolias, Konstantinos, Voumvourakis, Konstantinos, Stefanis, Leonidas, Filippatos, Gerasimos, Tsivgoulis, Georgios
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6912531/
https://www.ncbi.nlm.nih.gov/pubmed/31744102
http://dx.doi.org/10.3390/jcm8112002
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author Liantinioti, Chrissoula
Palaiodimou, Lina
Tympas, Konstantinos
Parissis, John
Theodorou, Aikaterini
Ikonomidis, Ignatios
Chondrogianni, Maria
Zompola, Christina
Triantafyllou, Sokratis
Roussopoulou, Andromachi
Kargiotis, Odysseas
Serdari, Aspasia
Bonakis, Anastasios
Vadikolias, Konstantinos
Voumvourakis, Konstantinos
Stefanis, Leonidas
Filippatos, Gerasimos
Tsivgoulis, Georgios
author_facet Liantinioti, Chrissoula
Palaiodimou, Lina
Tympas, Konstantinos
Parissis, John
Theodorou, Aikaterini
Ikonomidis, Ignatios
Chondrogianni, Maria
Zompola, Christina
Triantafyllou, Sokratis
Roussopoulou, Andromachi
Kargiotis, Odysseas
Serdari, Aspasia
Bonakis, Anastasios
Vadikolias, Konstantinos
Voumvourakis, Konstantinos
Stefanis, Leonidas
Filippatos, Gerasimos
Tsivgoulis, Georgios
author_sort Liantinioti, Chrissoula
collection PubMed
description Background: Occult paroxysmal atrial fibrillation (PAF) is a common and potential treatable cause of cryptogenic stroke (CS). We sought to prospectively identify independent predictors of atrial fibrillation (AF) detection in patients with CS and sinus rhythm on baseline electrocardiogram (ECG), without prior AF history. We had hypothesized that cardiac arrhythmia detection during neurosonology examinations (Carotid Duplex (CDU) and Transcranial Doppler (TCD)) may be associated with higher likelihood of AF detection. Methods: Consecutive CS patients were prospectively evaluated over a six-year period. Demographics, clinical and imaging characteristics of cerebral ischemia were documented. The presence of arrhythmia during spectral waveform analysis of CDU/TCD was recorded. Left atrial enlargement was documented during echocardiography using standard definitions. The outcome event of interest included PAF detection on outpatient 24-h Holter ECG recordings. Statistical analyses were performed using univariate and multivariate logistic regression models. Results: A total of 373 patients with CS were evaluated (mean age 60 ± 11 years, 67% men, median NIHSS-score 4 points). The rate of PAF detection of any duration on Holter ECG recordings was 11% (95% CI 8%–14%). The following three variables were independently associated with the likelihood of AF detection on 24-h Holter-ECG recordings in both multivariate analyses adjusting for potential confounders: age (OR per 10-year increase: 1.68; 95% CI: 1.19–2.37; p = 0.003), moderate or severe left atrial enlargement (OR: 4.81; 95% CI: 1.77–13.03; p = 0.002) and arrhythmia detection during neurosonology evaluations (OR: 3.09; 95% CI: 1.47–6.48; p = 0.003). Conclusion: Our findings underline the potential utility of neurosonology in improving the detection rate of PAF in patients with CS.
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spelling pubmed-69125312020-01-02 Potential Utility of Neurosonology in Paroxysmal Atrial Fibrillation Detection in Patients with Cryptogenic Stroke Liantinioti, Chrissoula Palaiodimou, Lina Tympas, Konstantinos Parissis, John Theodorou, Aikaterini Ikonomidis, Ignatios Chondrogianni, Maria Zompola, Christina Triantafyllou, Sokratis Roussopoulou, Andromachi Kargiotis, Odysseas Serdari, Aspasia Bonakis, Anastasios Vadikolias, Konstantinos Voumvourakis, Konstantinos Stefanis, Leonidas Filippatos, Gerasimos Tsivgoulis, Georgios J Clin Med Article Background: Occult paroxysmal atrial fibrillation (PAF) is a common and potential treatable cause of cryptogenic stroke (CS). We sought to prospectively identify independent predictors of atrial fibrillation (AF) detection in patients with CS and sinus rhythm on baseline electrocardiogram (ECG), without prior AF history. We had hypothesized that cardiac arrhythmia detection during neurosonology examinations (Carotid Duplex (CDU) and Transcranial Doppler (TCD)) may be associated with higher likelihood of AF detection. Methods: Consecutive CS patients were prospectively evaluated over a six-year period. Demographics, clinical and imaging characteristics of cerebral ischemia were documented. The presence of arrhythmia during spectral waveform analysis of CDU/TCD was recorded. Left atrial enlargement was documented during echocardiography using standard definitions. The outcome event of interest included PAF detection on outpatient 24-h Holter ECG recordings. Statistical analyses were performed using univariate and multivariate logistic regression models. Results: A total of 373 patients with CS were evaluated (mean age 60 ± 11 years, 67% men, median NIHSS-score 4 points). The rate of PAF detection of any duration on Holter ECG recordings was 11% (95% CI 8%–14%). The following three variables were independently associated with the likelihood of AF detection on 24-h Holter-ECG recordings in both multivariate analyses adjusting for potential confounders: age (OR per 10-year increase: 1.68; 95% CI: 1.19–2.37; p = 0.003), moderate or severe left atrial enlargement (OR: 4.81; 95% CI: 1.77–13.03; p = 0.002) and arrhythmia detection during neurosonology evaluations (OR: 3.09; 95% CI: 1.47–6.48; p = 0.003). Conclusion: Our findings underline the potential utility of neurosonology in improving the detection rate of PAF in patients with CS. MDPI 2019-11-16 /pmc/articles/PMC6912531/ /pubmed/31744102 http://dx.doi.org/10.3390/jcm8112002 Text en © 2019 by the authors. 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 (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Liantinioti, Chrissoula
Palaiodimou, Lina
Tympas, Konstantinos
Parissis, John
Theodorou, Aikaterini
Ikonomidis, Ignatios
Chondrogianni, Maria
Zompola, Christina
Triantafyllou, Sokratis
Roussopoulou, Andromachi
Kargiotis, Odysseas
Serdari, Aspasia
Bonakis, Anastasios
Vadikolias, Konstantinos
Voumvourakis, Konstantinos
Stefanis, Leonidas
Filippatos, Gerasimos
Tsivgoulis, Georgios
Potential Utility of Neurosonology in Paroxysmal Atrial Fibrillation Detection in Patients with Cryptogenic Stroke
title Potential Utility of Neurosonology in Paroxysmal Atrial Fibrillation Detection in Patients with Cryptogenic Stroke
title_full Potential Utility of Neurosonology in Paroxysmal Atrial Fibrillation Detection in Patients with Cryptogenic Stroke
title_fullStr Potential Utility of Neurosonology in Paroxysmal Atrial Fibrillation Detection in Patients with Cryptogenic Stroke
title_full_unstemmed Potential Utility of Neurosonology in Paroxysmal Atrial Fibrillation Detection in Patients with Cryptogenic Stroke
title_short Potential Utility of Neurosonology in Paroxysmal Atrial Fibrillation Detection in Patients with Cryptogenic Stroke
title_sort potential utility of neurosonology in paroxysmal atrial fibrillation detection in patients with cryptogenic stroke
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6912531/
https://www.ncbi.nlm.nih.gov/pubmed/31744102
http://dx.doi.org/10.3390/jcm8112002
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