Identification of magnetic resonance imaging features for the prediction of unrecognized atrial fibrillation in acute ischemic stroke
Background and purposeThe early identification of cardioembolic stroke is critical for the early initiation of anticoagulant treatment. However, it can be challenging to identify the major cardiac source, particularly since the predominant source, paroxysmal atrial fibrillation (AF), may not be pres...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-09-01
|
| Series: | Frontiers in Neurology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2022.952462/full |
| _version_ | 1811211147978735616 |
|---|---|
| author | Chao-Hui Chen Meng Lee Hsu-Huei Weng Jiann-Der Lee Jen-Tsung Yang Yuan-Hsiung Tsai Yen-Chu Huang |
| author_facet | Chao-Hui Chen Meng Lee Hsu-Huei Weng Jiann-Der Lee Jen-Tsung Yang Yuan-Hsiung Tsai Yen-Chu Huang |
| author_sort | Chao-Hui Chen |
| collection | DOAJ |
| description | Background and purposeThe early identification of cardioembolic stroke is critical for the early initiation of anticoagulant treatment. However, it can be challenging to identify the major cardiac source, particularly since the predominant source, paroxysmal atrial fibrillation (AF), may not be present at the time of stroke. In this study, we aimed to evaluate imaging predictors for unrecognized AF in patients with acute ischemic stroke.MethodsWe performed a cross-sectional analysis of data and magnetic resonance imaging (MRI) scans from two prospective cohorts of patients who underwent serial 12-lead electrocardiography and 24-h Holter monitoring to detect unrecognized AF. The imaging patterns in diffusion-weighted imaging and imaging characteristics were assessed and classified. A logistic regression model was used to identify predictive factors for newly detected AF in patients with acute ischemic stroke.ResultsA total of 734 patients were recruited for analysis, with a median age of 72 (interquartile range: 65–79) years and a median National Institutes of Health Stroke Scale score of 4 (interquartile range: 2–6). Of these patients, 64 (8.7%) had newly detected AF during the follow-up period. Stepwise multivariate logistic regression revealed that age ≥75 years [adjusted odds ratio (aOR) 5.66, 95% confidence interval (CI) 2.98–10.75], receiving recombinant tissue plasminogen activator treatment (aOR 4.36, 95% CI 1.65–11.54), congestive heart failure (aOR 6.73, 95% CI 1.85–24.48), early hemorrhage in MRI (aOR 3.62, 95% CI 1.52–8.61), single cortical infarct (aOR 6.49, 95% CI 2.35–17.92), and territorial infarcts (aOR 3.54, 95% CI 1.06–11.75) were associated with newly detected AF. The C-statistic of the prediction model for newly detected AF was 0.764.ConclusionInitial MRI at the time of stroke may be useful to predict which patients have cardioembolic stroke caused by unrecognized AF. Further studies are warranted to verify these findings and their application to high-risk patients. |
| first_indexed | 2024-04-12T05:07:49Z |
| format | Article |
| id | doaj.art-0d9565ab4130473c8c020396107ddafd |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-12T05:07:49Z |
| publishDate | 2022-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-0d9565ab4130473c8c020396107ddafd2022-12-22T03:46:50ZengFrontiers Media S.A.Frontiers in Neurology1664-22952022-09-011310.3389/fneur.2022.952462952462Identification of magnetic resonance imaging features for the prediction of unrecognized atrial fibrillation in acute ischemic strokeChao-Hui Chen0Meng Lee1Hsu-Huei Weng2Jiann-Der Lee3Jen-Tsung Yang4Yuan-Hsiung Tsai5Yen-Chu Huang6Department of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi City, TaiwanDepartment of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi City, TaiwanDepartment of Diagnostic Radiology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi City, TaiwanDepartment of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi City, TaiwanDepartment of Neurosurgery, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi City, TaiwanDepartment of Diagnostic Radiology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi City, TaiwanDepartment of Neurology, Chang Gung Memorial Hospital at Chiayi, Chang-Gung University College of Medicine, Chiayi City, TaiwanBackground and purposeThe early identification of cardioembolic stroke is critical for the early initiation of anticoagulant treatment. However, it can be challenging to identify the major cardiac source, particularly since the predominant source, paroxysmal atrial fibrillation (AF), may not be present at the time of stroke. In this study, we aimed to evaluate imaging predictors for unrecognized AF in patients with acute ischemic stroke.MethodsWe performed a cross-sectional analysis of data and magnetic resonance imaging (MRI) scans from two prospective cohorts of patients who underwent serial 12-lead electrocardiography and 24-h Holter monitoring to detect unrecognized AF. The imaging patterns in diffusion-weighted imaging and imaging characteristics were assessed and classified. A logistic regression model was used to identify predictive factors for newly detected AF in patients with acute ischemic stroke.ResultsA total of 734 patients were recruited for analysis, with a median age of 72 (interquartile range: 65–79) years and a median National Institutes of Health Stroke Scale score of 4 (interquartile range: 2–6). Of these patients, 64 (8.7%) had newly detected AF during the follow-up period. Stepwise multivariate logistic regression revealed that age ≥75 years [adjusted odds ratio (aOR) 5.66, 95% confidence interval (CI) 2.98–10.75], receiving recombinant tissue plasminogen activator treatment (aOR 4.36, 95% CI 1.65–11.54), congestive heart failure (aOR 6.73, 95% CI 1.85–24.48), early hemorrhage in MRI (aOR 3.62, 95% CI 1.52–8.61), single cortical infarct (aOR 6.49, 95% CI 2.35–17.92), and territorial infarcts (aOR 3.54, 95% CI 1.06–11.75) were associated with newly detected AF. The C-statistic of the prediction model for newly detected AF was 0.764.ConclusionInitial MRI at the time of stroke may be useful to predict which patients have cardioembolic stroke caused by unrecognized AF. Further studies are warranted to verify these findings and their application to high-risk patients.https://www.frontiersin.org/articles/10.3389/fneur.2022.952462/fullischemic strokecryptogenic strokecardioembolic strokeMRIatrial fibrillation |
| spellingShingle | Chao-Hui Chen Meng Lee Hsu-Huei Weng Jiann-Der Lee Jen-Tsung Yang Yuan-Hsiung Tsai Yen-Chu Huang Identification of magnetic resonance imaging features for the prediction of unrecognized atrial fibrillation in acute ischemic stroke Frontiers in Neurology ischemic stroke cryptogenic stroke cardioembolic stroke MRI atrial fibrillation |
| title | Identification of magnetic resonance imaging features for the prediction of unrecognized atrial fibrillation in acute ischemic stroke |
| title_full | Identification of magnetic resonance imaging features for the prediction of unrecognized atrial fibrillation in acute ischemic stroke |
| title_fullStr | Identification of magnetic resonance imaging features for the prediction of unrecognized atrial fibrillation in acute ischemic stroke |
| title_full_unstemmed | Identification of magnetic resonance imaging features for the prediction of unrecognized atrial fibrillation in acute ischemic stroke |
| title_short | Identification of magnetic resonance imaging features for the prediction of unrecognized atrial fibrillation in acute ischemic stroke |
| title_sort | identification of magnetic resonance imaging features for the prediction of unrecognized atrial fibrillation in acute ischemic stroke |
| topic | ischemic stroke cryptogenic stroke cardioembolic stroke MRI atrial fibrillation |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2022.952462/full |
| work_keys_str_mv | AT chaohuichen identificationofmagneticresonanceimagingfeaturesforthepredictionofunrecognizedatrialfibrillationinacuteischemicstroke AT menglee identificationofmagneticresonanceimagingfeaturesforthepredictionofunrecognizedatrialfibrillationinacuteischemicstroke AT hsuhueiweng identificationofmagneticresonanceimagingfeaturesforthepredictionofunrecognizedatrialfibrillationinacuteischemicstroke AT jiannderlee identificationofmagneticresonanceimagingfeaturesforthepredictionofunrecognizedatrialfibrillationinacuteischemicstroke AT jentsungyang identificationofmagneticresonanceimagingfeaturesforthepredictionofunrecognizedatrialfibrillationinacuteischemicstroke AT yuanhsiungtsai identificationofmagneticresonanceimagingfeaturesforthepredictionofunrecognizedatrialfibrillationinacuteischemicstroke AT yenchuhuang identificationofmagneticresonanceimagingfeaturesforthepredictionofunrecognizedatrialfibrillationinacuteischemicstroke |