Abstract TP219: ACE2L: A Novel Scoring Tool With High Sensitivity And Specificity In Predicting Atrial Fibrillation In Cryptogenic Stroke

Abstract

Introduction/Background: Stroke is a leading cause of serious, long-term disability and death worldwide. Atrial fibrillation (AF) is the most common form of sustained cardiac arrhythmia, and is associated with a high risk of ischemic stroke and thromboembolism. Many cryptogenic strokes may be due to underlying, undetected paroxysmal AF. We performed a retrospective evaluation of patients with a history of ischemic stroke who were subsequently diagnosed with AF in order to develop a novel risk score calculator to help guide management in patients with cryptogenic stroke. Methods: We evaluated patients with a history of ischemic stroke both with and without a subsequent diagnosis of AF. Patients with a pre-existing diagnosis of AF were excluded. 1 point was assigned for each of the following: (1) age > 60; (2) cortical ischemic stroke; (3) embolic appearance on imaging; (4) p-wave terminal force > 5000 μVms; (5) increased left atrial volume index; (6) lack of extracranial large vessel occlusion (LVO). Patients with ipsilateral extracranial LVO and patients with LVO > 70% were excluded. Results: A total of 74 patients with a diagnosis of ischemic stroke were evaluated. Of these, 41 patients had a subsequent diagnosis of AF, and 33 patients did not. A score of 4 or higher correlated with a sensitivity of 86.8% (95% CI: 72.7%, 94.2%), specificity of 100% (95% CI 89.8%, 100%), PPV 100% (95% CI 89.6%, 100%), NPV 87.2% (95% CI 73.3%, 94.4%), negative likelihood ratio 0.13 (95% CI 5.8%, 29.8%), and accuracy 93.1% (95% CI 84.8%, 897%). Conclusions: The novel ACE2L scoring tool demonstrated high sensitivity and specificity in predicting atrial fibrillation in patients with ischemic stroke. This scoring tool utilizes factors readily accessible in the evaluation of acute stroke and is a simple tool that may be used to help guide further management. Future, prospective studies are needed to further validate this scoring tool.