Cargando…

Atrial CARdiac Magnetic resonance imaging in patients with embolic stroke of unknown source without documented Atrial Fibrillation (CARM-AF): Study design and clinical protocol

BACKGROUND: Initiation of anticoagulation therapy in ischemic stroke patients is contingent on a clinical diagnosis of atrial fibrillation (AF). Results from previous studies suggest thromboembolic risk may predate clinical manifestations of AF. Early identification of this cohort of patients may al...

Descripción completa

Detalles Bibliográficos
Autores principales: Kotadia, Irum D., O’Dowling, Robert, Aboagye, Akosua, Sim, Iain, O’Hare, Daniel, Lemus-Solis, José-Alonso, Roney, Caroline H., Dweck, Marc, Chiribiri, Amedeo, Plein, Sven, Sztriha, Laszlo, Scott, Paul, Harrison, James, Ramsay, Deborah, Birns, Jonathan, Somerville, Peter, Bhalla, Ajay, Niederer, Steven, O’Neill, Mark, Williams, Steven E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9043416/
https://www.ncbi.nlm.nih.gov/pubmed/35496458
http://dx.doi.org/10.1016/j.hroo.2022.01.005
Descripción
Sumario:BACKGROUND: Initiation of anticoagulation therapy in ischemic stroke patients is contingent on a clinical diagnosis of atrial fibrillation (AF). Results from previous studies suggest thromboembolic risk may predate clinical manifestations of AF. Early identification of this cohort of patients may allow early initiation of anticoagulation and reduce the risk of secondary stroke. OBJECTIVE: This study aims to produce a substrate-based predictive model using cardiac magnetic resonance imaging (CMR) and baseline noninvasive electrocardiographic investigations to improve the identification of patients at risk of future thromboembolism. METHODS: CARM-AF is a prospective, multicenter, observational cohort study. Ninety-two patients will be recruited following an embolic stroke of unknown source (ESUS) and undergo atrial CMR followed by insertion of an implantable loop recorder (ILR) as per routine clinical care within 3 months of index stroke. Remote ILR follow-up will be used to allocate patients to a study or control group determined by the presence or absence of AF as defined by ILR monitoring. RESULTS: Baseline data collection, noninvasive electrocardiographic data analysis, and imaging postprocessing will be performed at the time of enrollment. Primary analysis will be performed following 12 months of continuous ILR monitoring, with interim and delayed analyses performed at 6 months and 2 and 3 years, respectively. CONCLUSION: The CARM-AF Study will use atrial structural and electrocardiographic metrics to identify patients with AF, or at high risk of developing AF, who may benefit from early initiation of anticoagulation.