title: A Score for Predicting Paroxysmal Atrial Fibrillation in Acute Stroke Patients: iPAB Score.
abstract: BACKGROUND
  Detection of paroxysmal atrial fibrillation (PAF) after a stroke is challenging. The purpose of this study was to develop a clinical score to predict PAF in a cohort of acute ischemic stroke patients prospectively and to validate it in an independent cohort.
  
  
  METHODS
  Consecutive acute ischemic stroke patients without permanent atrial fibrillation were enrolled in a derivation sample (n = 294) or a validation sample (n = 155). We developed a score for predicting PAF by independent risk factors derived from a logistic regression analysis of the derivation cohort and validated the score in the external cohort.
  
  
  RESULTS
  Multivariate analysis in the derivation cohort identified 3 variables independently associated with PAF. We calculated a score from these variables (history of arrhythmia or antiarrhythmic agent use [yes, 3 points], left atrial dilation [≥40 mm, 1 point], brain natriuretic peptide [BNP, ≥50 pg/mL, 1 point; ≥90 pg/mL, 2 points; ≥150 pg/ml, 3 points], total score, 0-7). The iPAB score (identified by past history of arrhythmia or antiarrhythmic agent use, atrial dilation, and BNP elevation) predicted PAF in the derivation (c statistic, .90) and validation (.94) cohorts at levels statistically superior to other biomarkers and clinical scores. For a total score 2 or more, the sensitivity and specificity were 93% and 71%, respectively. For a total score of 4 or more, the corresponding values were 60% and 95%.
  
  
  CONCLUSIONS
  Our prospective study suggests that this simple risk score superior to other scores help clinicians predict PAF or identify good candidates for further evaluation to detect PAF.
authors.affiliation: Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Bunkyo-Ku, Tokyo, Japan; Department of Neurology, Yokohama City Minato Red Cross Hospital, Yokohama, Japan. Electronic address: kotanuro@tmd.ac.jp.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Yoshioka
authors.affiliation: Department of Neurology, Yokohama City Minato Red Cross Hospital, Yokohama, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: Department Neurology, National Disaster Medical Center, Tachikawa, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Zeniya
authors.affiliation: Department Neurology, National Disaster Medical Center, Tachikawa, Tokyo, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Ito
authors.affiliation: Department of Neurology, Yokohama City Minato Red Cross Hospital, Yokohama, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Hizume
authors.affiliation: Department of Neurology, Yokohama City Minato Red Cross Hospital, Yokohama, Japan.
authors.forename: Toshiro
authors.initials: T
authors.lastname: Kanazawa
authors.affiliation: Clinical Research Center, Tokyo Medical and Dental University, Bunkyo-Ku, Tokyo, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Tomita
authors.affiliation: Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Bunkyo-Ku, Tokyo, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Ishibashi
authors.affiliation: Department Neurology, National Disaster Medical Center, Tachikawa, Tokyo, Japan.
authors.forename: Hirotomo
authors.initials: H
authors.lastname: Miake
authors.affiliation: Department of Neurology, Yokohama City Minato Red Cross Hospital, Yokohama, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Bunkyo-Ku, Tokyo, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Yokota
authors.affiliation: Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Bunkyo-Ku, Tokyo, Japan.
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Mizusawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000209:etiology*; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications*
chemical_list: D020097:Natriuretic Peptide, Brain
keywords: Acute ischemic stroke; brain natriuretic peptide; cardioembolism; paroxysmal atrial fibrillation