title: Biomarkers of Atrial Cardiopathy and Atrial Fibrillation Detection on Mobile Outpatient Continuous Telemetry After Embolic Stroke of Undetermined Source.
abstract: BACKGROUND
  Biomarkers of atrial dysfunction or "cardiopathy" are associated with embolic stroke risk. However, it is unclear if this risk is mediated by undiagnosed paroxysmal atrial fibrillation or flutter (AF). We aim to determine whether atrial cardiopathy biomarkers predict AF on continuous heart-rhythm monitoring after embolic stroke of undetermined source (ESUS).
  
  
  METHODS
  This was a single-center retrospective study including all patients with ESUS undergoing 30 days of ambulatory heart-rhythm monitoring to look for AF between January 1, 2013 and December 31, 2015. We reviewed medical records for clinical, radiographic, and cardiac variables. The primary outcome was a new diagnosis of AF detected during heart-rhythm monitoring. The primary predictors were atrial biomarkers: left atrial diameter on echocardiography, P-wave terminal force in electrocardiogram (ECG) lead V1, and P wave - R wave (PR) interval on ECG. A multiple logistic regression model was used to assess the relationship between atrial biomarkers and AF detection.
  
  
  RESULTS
  Among 196 eligible patients, 23 (11.7%) were diagnosed with AF. In unadjusted analyses, patients with AF were older (72.4 years versus 61.4 years, P < .001) and had larger left atrial diameter (39.2 mm versus 35.7 mm, P = .03). In a multivariable model, the only predictor of AF was age ≥ 60 years (odds ratio, 3.0; 95% CI, 1.06-8.5; P = .04).
  
  
  CONCLUSIONS
  Atrial biomarkers were weakly associated with AF after ESUS. This suggests that previously reported associations between these markers and stroke may reflect independent cardiac pathways leading to stroke. Prospective studies are needed to investigate these mechanisms.
authors.affiliation: Department of Neurology, the Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Denise
authors.initials: D
authors.lastname: Sebasigari
authors.affiliation: Department of Neurology, Weill Cornell Medical College, New York, New York; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York.
authors.forename: Alexander
authors.initials: A
authors.lastname: Merkler
authors.affiliation: Department of Neurology, the Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Yang
authors.initials: Y
authors.lastname: Guo
authors.affiliation: Department of Neurology, Weill Cornell Medical College, New York, New York.
authors.forename: Gino
authors.initials: G
authors.lastname: Gialdini
authors.affiliation: Department of Neurology, Columbia University Medical Center, New York, New York.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Kummer
authors.affiliation: Department of Neurology, the Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Morgan
authors.initials: M
authors.lastname: Hemendinger
authors.affiliation: Department of Internal Medicine, Division of Cardiology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Christopher
authors.initials: C
authors.lastname: Song
authors.affiliation: Department of Internal Medicine, Division of Cardiology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Antony
authors.initials: A
authors.lastname: Chu
authors.affiliation: Department of Neurology, the Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Shawna
authors.initials: S
authors.lastname: Cutting
authors.affiliation: Department of Neurology, the Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Brian
authors.initials: B
authors.lastname: Silver
authors.affiliation: Department of Neurology, Columbia University Medical Center, New York, New York; Department of Epidemiology, The Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: Mitchell S V
authors.initials: MSV
authors.lastname: Elkind
authors.affiliation: Department of Neurology, Weill Cornell Medical College, New York, New York; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York.
authors.forename: Hooman
authors.initials: H
authors.lastname: Kamel
authors.affiliation: Department of Neurology, the Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Furie
authors.affiliation: Department of Neurology, the Warren Alpert Medical School of Brown University, Providence, Rhode Island. Electronic address: shadiyaghi@yahoo.com.
authors.forename: Shadi
authors.initials: S
authors.lastname: Yaghi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods*; D001281:Atrial Fibrillation / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D001282:Atrial Flutter / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D016280:Atrial Function, Right; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology*; D013686:Telemetry / Q000379:methods*; D016277:Ventricular Function, Left
keywords: Cryptogenic stroke; atrial cardiopathy; atrial fibrillation; embolic stroke of undetermined source; ischemic stroke