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Atrial Fibrillation After Ischemic Stroke Detected by Chest Strap-Style 7-Day Holter Monitoring and the Risk Predictors: EDUCATE-ESUS
- Source :
- Journal of Atherosclerosis and Thrombosis
- Publication Year :
- 2020
- Publisher :
- Japan Atherosclerosis Society, 2020.
-
Abstract
- Aim This study aimed to investigate the diagnostic yield of 7-day Holter monitoring for detecting covert atrial fibrillation (AF) in patients with recent embolic stroke of undetermined source (ESUS) and to identify the pre-entry screening biomarkers that had significant associations with later detection of AF (clinicaltrials.gov. NCT02801708). Methods A total of 206 patients who have recent ESUS without previously documented AF underwent Holter electrocardiography using a chest strap-style monitor. External validation of biomarkers predictive of AF was performed using 83 patients with ESUS who were implanted with insertable cardiac monitors. Results The 7-day Holter monitoring started at a median of 13 days after the onset of stroke. AF was detected in 14 patients, and three of these showed a single AF episode lasting <2 min. The median time delay to the first documented AF was 50 h. Each of serum brain natriuretic peptide ≥ 66.0 pg/mL (adjusted odds ratio 5.23), atrial premature contractions (APCs) ≥ 345 beats (3.80), and APC short runs ≥ 13 (5.74) on 24-h Holter prior to the 7-day Holter showed a significant association with detection of AF, independent of age and physiological findings in this derivation cohort, and all of these showed a significant association in the validation cohort (adjusted odds ratio 6.59, 7.87, and 6.16, respectively). Conclusions In recent ESUS patients, the detection rate of AF using the 7-day Holter monitoring was 6.8% (95% CI 4.1%-11.1%). Brain natriuretic peptide, APC count, and APC short runs in the standard clinical workup seemed to be predictors of covert AF.
- Subjects :
- Male
medicine.medical_specialty
Time Factors
Cardioembolism
030204 cardiovascular system & hematology
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Insertable cardiac monitors
Predictive Value of Tests
Internal medicine
Atrial Fibrillation
Natriuretic Peptide, Brain
Internal Medicine
medicine
Acute stroke
Humans
In patient
Stroke
Aged
Aged, 80 and over
Embolic Stroke
business.industry
Biochemistry (medical)
External validation
Atrial premature contraction
Atrial fibrillation
Odds ratio
Middle Aged
medicine.disease
Brain natriuretic peptide
Ischemic stroke
Cardiology
Electrocardiography, Ambulatory
Original Article
Female
Cardiology and Cardiovascular Medicine
business
Holter monitoring
030217 neurology & neurosurgery
Biomarkers
Subjects
Details
- Language :
- English
- ISSN :
- 18803873 and 13403478
- Volume :
- 28
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- Journal of Atherosclerosis and Thrombosis
- Accession number :
- edsair.doi.dedup.....08f392824db655005db3548f53823014