Multimodal Approach for the Prediction of Atrial Fibrillation Detected After Stroke: SAFAS Study

Lucie Garnier, Gauthier Duloquin, Alexandre Meloux, Karim Benali, Audrey Sagnard, Mathilde Graber, Geoffrey Dogon, Romain Didier, Thibaut Pommier, Catherine Vergely, Yannick Béjot, Charles Guenancia, Lucie Garnier, Gauthier Duloquin, Alexandre Meloux, Karim Benali, Audrey Sagnard, Mathilde Graber, Geoffrey Dogon, Romain Didier, Thibaut Pommier, Catherine Vergely, Yannick Béjot, Charles Guenancia

Abstract

Background: Intensive screening for atrial fibrillation (AF) has led to a better recognition of this cause in stroke patients. However, it is currently debated whether AF Detected After Stroke (AFDAS) has the same pathophysiology and embolic risk as prior-to-stroke AF. We thus aimed to systematically approach AFDAS using a multimodal approach combining clinical, imaging, biological and electrocardiographic markers.

Methods: Patients without previously known AF admitted to the Dijon University Hospital (France) stroke unit for acute ischemic stroke were prospectively enrolled. The primary endpoint was the presence of AFDAS at 6 months, diagnosed through admission ECG, continuous electrocardiographic monitoring, long-term external Holter during the hospital stay, or implantable cardiac monitor if clinically indicated after discharge.

Results: Of the 240 included patients, 77 (32%) developed AFDAS. Compared with sinus rhythm patients, those developing AFDAS were older, more often women and less often active smokers. AFDAS patients had higher blood levels of NT-proBNP, osteoprotegerin, galectin-3, GDF-15 and ST2, as well as increased left atrial indexed volume and lower left ventricular ejection fraction. After multivariable analysis, galectin-3 ≧ 9 ng/ml [OR 3.10; 95% CI (1.03-9.254), p = 0.042], NT-proBNP ≧ 290 pg/ml [OR 3.950; 95% CI (1.754-8.892, p = 0.001], OPG ≥ 887 pg/ml [OR 2.338; 95% CI (1.015-5.620), p = 0.046) and LAVI ≥ 33.5 ml/m2 [OR 2.982; 95% CI (1.342-6.625), p = 0.007] were independently associated with AFDAS.

Conclusion: A multimodal approach combining imaging, electrocardiography and original biological markers resulted in good predictive models for AFDAS. These results also suggest that AFDAS is probably related to an underlying atrial cardiopathy.

Clinical trial registration: [www.ClinicalTrials.gov], identifier [NCT03570060].

Keywords: Holter; atrial cardiopathy; atrial fibrillation; biomarkers; echocardiography; stroke.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Garnier, Duloquin, Meloux, Benali, Sagnard, Graber, Dogon, Didier, Pommier, Vergely, Béjot and Guenancia.

Figures

FIGURE 1
FIGURE 1
Flow chart of the SAFAS study.
FIGURE 2
FIGURE 2
ROC curve for models 1 and 2. Model 1 associates galectin-3 = 9 ng/ml; NT-pro-BNP ≥ 290 pg/ml; OPG ≥ 887 pg/ml and LAVI ≥ 33.5 ml/m2 for all AFDAS prediction (n = 240). Model 2 associates galectin-3 ≥ 9 ng/ml; NT-Pro-BNP ≥ 290 pg/ml; OPG ≥ 887 pg/ml and pNN50 ≥ 11 for AFDAS occurring after a stay in the stroke unit: AUC, area under the curve. OPG, osteoprotegerin.
FIGURE 3
FIGURE 3
SAFAS study main results.

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