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Atrial fibrillation risk stratification after ischemic stroke - what can be done with usual work up diagnostic tools.
Session:
Painel 11 - Doença Aórtica 1
Speaker:
Rita Carvalheira dos Santos
Congress:
CPC 2020
Topic:
G. Aortic Disease, Peripheral Vascular Disease, Stroke
Theme:
24. Stroke
Subtheme:
24.3 Stroke - Diagnostic Methods
Session Type:
Posters
FP Number:
---
Authors:
Rita Carvalheira Dos Santos ; Rita Gomes; Pedro Custódio; Joana Neiva; Rita Duarte; Pedro Bico; Helena Ribeiro; Fernando Matias; Carlos Mendonça; Luis Nuno; António Rocha Almeida; Carlos Rabaçal
Abstract
<p><strong>Introduction</strong></p> <p>Atrial fibrillation (AF) is a common cause of stroke. Common work up usually fails to diagnose it soon after the event.</p> <p><strong>Aim</strong></p> <p>To assess the clinical predictors of AF in patients presenting with stroke and to derive a risk predictive score of AF that may help in further management of this patients. </p> <p><strong>Methods and population</strong></p> <p>Single center retrospective analysis including 223 consecutive patients presenting with stroke without previously known AF between January 2016 and December 2016. Univariate analysis was used to find variables associated with AF at long-term, and multivariate analysis including clinical important known factors to be associated with AF and those variables that showed to be associated with AF in the long-term in the Univariate analysis. ROC curve analysis was performed to assess the discriminative power of the model. </p> <p><strong>Results</strong></p> <p>The mean age was 72 ±12 yo, 47% were male. At 3-year follow up, 47 patients (21%) had AF diagnosed. Patients with AF at long term were older (76±9 vs 71± 12, p=0.002), had larger left atrium (LA) (41 [38-48]ml/m2 vs 27 [25-33] ml/m2, p=), greater ectopic beat burden (1,35 [0,2-3,3]% vs 0,2 [0-0,6]%, p=) and greater serum creatinine (1,3 ± 0,8 vs 1 ± 0,5, p=0,009). There were no differences (p>0.05) in gender , hypertension, diabetes, sleep apnea,, congestive heart failure, ejection fraction, mitral valve disease, between groups.. The only independent predictor of long-term AF was LA dimension OR 1.16 (95% CI 1.07-1,25). The model including LA dimensions, ectopic beat burden, creatinine, age, hypertension, diabetes, sleep apnea and previous stroke showed an AUC of 0.91 (95% IC 0,85-0,97, p<0,001) for long-term AF prediction.</p> <p><strong>Concluions</strong></p> <p>Left atrium dimension was the only independent predictor of long-term AF in this single center cohort of patients with stroke. Notwithstanding other clinical important variables may be important to identify patients that may benefit from further investigation (implantable loop recorder) and therapy. The AF predictive model derived from the present population showed a good discriminative ability.</p>
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