Akershus University Hospital, Lørenskog, Norway.
University of Oslo, Oslo, Norway.
Europace. 2022 Dec 9;24(12):1881-1888. doi: 10.1093/europace/euac092.
Studies with implantable cardiac monitors (ICMs) show that one-third of patients with cryptogenic stroke/transient ischaemic attack (TIA) have episodes of subclinical atrial fibrillation (SCAF) and benefit switching from antiplatelet- to anticoagulant therapy. However, ICMs are costly and resource demanding. We aimed to build a score based on participant's baseline characteristics that could assess individual risk of SCAF.
In a prospective study, 236 eligible patients with a final diagnosis of cryptogenic stroke/TIA had an ICM implantated during the index hospitalization. Pre-specified evaluated variables were: CHA2DS2-VASc, P-wave duration, P-wave morphology, premature atrial beats (PAC)/24 h, supraventricular tachycardia/24 h, left atrial end-systolic volume index (LAVI), Troponin-T, NT-proBNP, and D-dimer. SCAF was detected in 84 patients (36%). All pre-specified variables were significantly associated with SCAF detection in univariate analysis. P-wave duration, followed by PAC/24 h, NT-proBNP, and LAVI, had the largest ratio of SCAF prevalence between its upper and lower quartiles (3.3, vs. 3.2, vs. 3.1 vs. 2.8, respectively). However, in a multivariate analysis, only PAC/24t, P-wave duration, P-wave morphology, and LAVIs remained significant predictors and were included in the PROACTIA score. Subclinical atrial fibrillation prevalence was 75% in the highest vs. 10% in the lowest quartile of the PROACTIA score with a 10-fold higher number of patients with an atrial fibrillation burden >6 h in the highest vs. the lowest quartile.
The PROACTIA score can identify patients with cryptogenic stroke/TIA at risk of subsequent SCAF detection. The large difference in SCAF prevalence between groups may provide a basis for future tailored therapy.
Clinical Trial Registration: ClinicalTrials.gov; NCT02725944.
植入式心脏监测器（ICM）的研究表明，三分之一的隐源性卒中/短暂性脑缺血发作（TIA）患者有亚临床房颤（SCAF）发作，并从抗血小板治疗转为抗凝治疗中获益。然而，ICM 成本高且资源需求大。我们旨在构建一个基于参与者基线特征的评分，以评估个体发生 SCAF 的风险。
在一项前瞻性研究中，236 名最终诊断为隐源性卒中/TIA 的合格患者在住院期间植入了 ICM。预先指定评估的变量为：CHA2DS2-VASc、P 波持续时间、P 波形态、房性期前收缩（PAC）/24 小时、室上性心动过速/24 小时、左心房收缩末期容积指数（LAVI）、肌钙蛋白-T、NT-proBNP 和 D-二聚体。84 例（36%）患者检测到 SCAF。所有预先指定的变量在单变量分析中均与 SCAF 检测显著相关。P 波持续时间、其次是 PAC/24 小时、NT-proBNP 和 LAVI，其上下四分位数之间 SCAF 发生率的比值最大（3.3 比 3.2、3.1 比 2.8）。然而，在多变量分析中，只有 PAC/24 小时、P 波持续时间、P 波形态和 LAVI 仍然是显著的预测因子，并被纳入 PROACTIA 评分。PROACTIA 评分最高四分位组的 SCAF 发生率为 75%，而最低四分位组为 10%，且最高四分位组的心房颤动负荷>6 小时的患者数量是最低四分位组的 10 倍。
PROACTIA 评分可以识别隐源性卒中/TIA 患者发生 SCAF 的风险。两组之间 SCAF 发生率的巨大差异可能为未来的个体化治疗提供依据。
临床试验注册：ClinicalTrials.gov；NCT02725944。
