Risk scores for prediction of paroxysmal atrial fibrillation after acute ischemic stroke or transient ischemic attack: A systematic review and meta-analysis
Introduction: Detection of paroxysmal atrial fibrillation (PAF) is crucial for secondary prevention in patients with recent strokes of unknown etiology. This systematic review and meta-analysis assess the predictive power of available risk scores for detecting new PAF after acute ischemic stroke (AI...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-06-01
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| Series: | International Journal of Cardiology. Cardiovascular Risk and Prevention |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S277248752400014X |
| _version_ | 1797267100530638848 |
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| author | Sina Kazemian Diana Zarei Ali Bozorgi Saman Nazarian Mahbod Issaiy Hamed Tavolinejad Ozra Tabatabaei-Malazy Haleh Ashraf |
| author_facet | Sina Kazemian Diana Zarei Ali Bozorgi Saman Nazarian Mahbod Issaiy Hamed Tavolinejad Ozra Tabatabaei-Malazy Haleh Ashraf |
| author_sort | Sina Kazemian |
| collection | DOAJ |
| description | Introduction: Detection of paroxysmal atrial fibrillation (PAF) is crucial for secondary prevention in patients with recent strokes of unknown etiology. This systematic review and meta-analysis assess the predictive power of available risk scores for detecting new PAF after acute ischemic stroke (AIS). Methods: PubMed, Embase, Scopus, and Web of Science databases were searched until September 2023 to identify relevant studies. A bivariate random effects meta-analysis model pooled data on sensitivity, specificity, and area under the curve (AUC) for each score. The QUADAS-2 tool was used for the quality assessment. Results: Eventually, 21 studies with 18 original risk scores were identified. Age, left atrial enlargement, and NIHSS score were the most common predictive factors, respectively. Seven risk scores were meta-analyzed, with iPAB showing the highest pooled sensitivity and AUC (sensitivity: 89.4%, specificity: 74.2%, AUC: 0.83), and HAVOC having the highest pooled specificity (sensitivity: 46.3%, specificity: 82.0%, AUC: 0.82). Altogether, seven risk scores displayed good discriminatory power (AUC ≥0.80) with four of them (HAVOC, iPAB, Fujii, and MVP scores) being externally validated. Conclusion: Available risk scores demonstrate moderate to good predictive accuracy and can help identify patients who would benefit from extended cardiac monitoring after AIS. External validation is essential before widespread clinical adoption. |
| first_indexed | 2024-04-25T01:11:13Z |
| format | Article |
| id | doaj.art-35682ea82a4b4bebbe65d14d72c980b7 |
| institution | Directory Open Access Journal |
| issn | 2772-4875 |
| language | English |
| last_indexed | 2024-04-25T01:11:13Z |
| publishDate | 2024-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology. Cardiovascular Risk and Prevention |
| spelling | doaj.art-35682ea82a4b4bebbe65d14d72c980b72024-03-10T05:13:25ZengElsevierInternational Journal of Cardiology. Cardiovascular Risk and Prevention2772-48752024-06-0121200249Risk scores for prediction of paroxysmal atrial fibrillation after acute ischemic stroke or transient ischemic attack: A systematic review and meta-analysisSina Kazemian0Diana Zarei1Ali Bozorgi2Saman Nazarian3Mahbod Issaiy4Hamed Tavolinejad5Ozra Tabatabaei-Malazy6Haleh Ashraf7Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Cardiac Electrophysiology, Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, IranAdvanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IranDepartment of Cardiac Electrophysiology, Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, IranSection of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USAAdvanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IranDepartment of Cardiac Electrophysiology, Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, IranNon-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, IranCardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran; Corresponding author. Tehran Heart Center, Kargar St. Jalal al-Ahmad Cross, Tehran, Iran.Introduction: Detection of paroxysmal atrial fibrillation (PAF) is crucial for secondary prevention in patients with recent strokes of unknown etiology. This systematic review and meta-analysis assess the predictive power of available risk scores for detecting new PAF after acute ischemic stroke (AIS). Methods: PubMed, Embase, Scopus, and Web of Science databases were searched until September 2023 to identify relevant studies. A bivariate random effects meta-analysis model pooled data on sensitivity, specificity, and area under the curve (AUC) for each score. The QUADAS-2 tool was used for the quality assessment. Results: Eventually, 21 studies with 18 original risk scores were identified. Age, left atrial enlargement, and NIHSS score were the most common predictive factors, respectively. Seven risk scores were meta-analyzed, with iPAB showing the highest pooled sensitivity and AUC (sensitivity: 89.4%, specificity: 74.2%, AUC: 0.83), and HAVOC having the highest pooled specificity (sensitivity: 46.3%, specificity: 82.0%, AUC: 0.82). Altogether, seven risk scores displayed good discriminatory power (AUC ≥0.80) with four of them (HAVOC, iPAB, Fujii, and MVP scores) being externally validated. Conclusion: Available risk scores demonstrate moderate to good predictive accuracy and can help identify patients who would benefit from extended cardiac monitoring after AIS. External validation is essential before widespread clinical adoption.http://www.sciencedirect.com/science/article/pii/S277248752400014XAcute ischemic strokeCryptogenic strokeParoxysmal atrial fibrillationRisk scoreRisk stratification |
| spellingShingle | Sina Kazemian Diana Zarei Ali Bozorgi Saman Nazarian Mahbod Issaiy Hamed Tavolinejad Ozra Tabatabaei-Malazy Haleh Ashraf Risk scores for prediction of paroxysmal atrial fibrillation after acute ischemic stroke or transient ischemic attack: A systematic review and meta-analysis International Journal of Cardiology. Cardiovascular Risk and Prevention Acute ischemic stroke Cryptogenic stroke Paroxysmal atrial fibrillation Risk score Risk stratification |
| title | Risk scores for prediction of paroxysmal atrial fibrillation after acute ischemic stroke or transient ischemic attack: A systematic review and meta-analysis |
| title_full | Risk scores for prediction of paroxysmal atrial fibrillation after acute ischemic stroke or transient ischemic attack: A systematic review and meta-analysis |
| title_fullStr | Risk scores for prediction of paroxysmal atrial fibrillation after acute ischemic stroke or transient ischemic attack: A systematic review and meta-analysis |
| title_full_unstemmed | Risk scores for prediction of paroxysmal atrial fibrillation after acute ischemic stroke or transient ischemic attack: A systematic review and meta-analysis |
| title_short | Risk scores for prediction of paroxysmal atrial fibrillation after acute ischemic stroke or transient ischemic attack: A systematic review and meta-analysis |
| title_sort | risk scores for prediction of paroxysmal atrial fibrillation after acute ischemic stroke or transient ischemic attack a systematic review and meta analysis |
| topic | Acute ischemic stroke Cryptogenic stroke Paroxysmal atrial fibrillation Risk score Risk stratification |
| url | http://www.sciencedirect.com/science/article/pii/S277248752400014X |
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