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

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/m 2 [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.
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https://hal-univ-bourgogne.archives-ouvertes.fr/hal-03822534
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Soumis le : jeudi 20 octobre 2022 - 13:40:18
Dernière modification le : samedi 22 octobre 2022 - 03:23:43

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Lucie Garnier, Gauthier Duloquin, Alexandre Meloux, Karim Benali, Audrey Sagnard, et al.. Multimodal Approach for the Prediction of Atrial Fibrillation Detected After Stroke: SAFAS Study. Frontiers in Cardiovascular Medicine, 2022, 9, pp.949213. ⟨10.3389/fcvm.2022.949213⟩. ⟨hal-03822534⟩

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