Cardiology Department, University Hospital, Dijon, France.
Cardiology Department, University Hospital, Saint-Etienne, France.
J Stroke Cerebrovasc Dis. 2024 Jan;33(1):107451. doi: 10.1016/j.jstrokecerebrovasdis.2023.107451. Epub 2023 Nov 22.
Up to 20 % of ischemic strokes are associated with overt atrial fibrillation (AF). Furthermore, silent AF was detected by an implantable cardiac monitor (ICM) in 1 in 3 cryptogenic strokes in the CRYSTAL AF study. An ESC position paper has suggested a HAVOC score ≥ 4 or a Brown ESUS-AF score ≥ 2 as criteria for ICM implantation after cryptogenic stroke, but neither of these criteria has been developed or validated in ICM populations. We assessed the performance of HAVOC and Brown ESUS-AF scores in a cohort of ICM patients implanted after embolic stroke of undetermined source (ESUS).
All patients implanted with an ICM for ESUS between February 2016 and February 2022 at two French University Hospitals were retrospectively included. Demographic data, cardiovascular risk factors, and clinical and biological data were collected after a review of electronic medical records. HAVOC and Brown ESUS-AF scores were calculated for all patients.
Among the 384 patients included, 106 (27 %) developed AF during a mean follow-up of 33 months. The scores performances for predicting AF during follow-up were: HAVOC= AUC: 68.5 %, C-Index: 0.662, and Brown ESUS-AF=AUC: 72.9 %, C-index 0.712. Compared with the CHADS-VASc score, only the Brown ESUS-AF score showed significant improvement in NRI/IDI. Furthermore, classifying patients according to the suggested HAVOC and Brown ESUS-AF thresholds, only 24 % and 31 % of the cohort, respectively, would have received an ICM, and 58 (55 %) and 47 (44 %) of the AF patients, respectively, would not have been implanted with an ICM.
HAVOC and Brown ESUS-AF scores showed close and moderate performance in predicting AF on ICM after cryptogenic stroke, with a significant lack of sensitivity. Specific risk scores should be developed and validated in large ICM cohorts.
多达 20%的缺血性卒中与显性心房颤动（AF）有关。此外，CRYSTAL AF 研究中，在 3 例隐源性卒中患者中，通过植入式心脏监测器（ICM）检测到无症状 AF。ESC 立场文件建议，对于隐源性卒中后植入 ICM，HAVOC 评分≥4 或 Brown ESUS-AF 评分≥2 可作为植入标准，但这两种标准均未在 ICM 人群中开发或验证。我们评估了 HAVOC 和 Brown ESUS-AF 评分在隐源性卒中后接受栓塞性卒中（ESUS）的 ICM 患者队列中的表现。
回顾性纳入 2016 年 2 月至 2022 年 2 月在法国两所大学医院接受 ICM 植入治疗 ESUS 的所有患者。通过电子病历回顾收集人口统计学数据、心血管危险因素以及临床和生物学数据。为所有患者计算 HAVOC 和 Brown ESUS-AF 评分。
在 384 例患者中，106 例（27%）在平均 33 个月的随访期间发生 AF。在随访期间预测 AF 的评分表现为：HAVOC=AUC：68.5%，C 指数：0.662，Brown ESUS-AF=AUC：72.9%，C 指数 0.712。与 CHADS-VASc 评分相比，仅 Brown ESUS-AF 评分在 NRI/IDI 方面有显著改善。此外，根据建议的 HAVOC 和 Brown ESUS-AF 阈值对患者进行分类，分别只有 24%和 31%的患者会接受 ICM，分别有 58（55%）和 47（44%）例 AF 患者不会植入 ICM。
HAVOC 和 Brown ESUS-AF 评分在预测隐源性卒中后 ICM 发生 AF 方面表现出密切且中等的性能，但灵敏度显著不足。应在大型 ICM 队列中开发和验证特定的风险评分。
