Predicting Paroxysmal Atrial Fibrillation in Patients with Embolic Stroke of Undetermined Source (Esus) In the Real-World Practice: Comparison Between Brown-Af, As5f And Cha2ds2-Vasc Scores

Abstract

Introduction: Searching paroxysmal atrial fibrillation (PAF) is fundamental and strongly recommended in patients suffering from cryptogenic stroke or embolic stroke of undetermined source (ESUS). In the latest years some prediction scores for detecting post-stroke PAF have been proposed, such as Brown-AF and AS5F. However, external validations lack. The aim of the present study was to analyze the predictive power of AS5F and Brown-AF scores and compare them with the CHA2DS2-VASc score. Materials and Methods We analyzed demographic, clinical, trans-thoracic echocardiography and brain computer tomography characteristics of patients with ESUS undergone to two weeks external ECG monitoring after hospital discharge. PAF was considered detected when any evidence of AF and/or atrial flutter occurred at monitoring. For each patient we calculated the Brown-AF, AS5F and CHA2DS2-VASc scores and we analyzed and compared their predictive power by using area under the Receiver Operating Curve (AUROC). Results: Eighty-two consecutive ESUS patients with mean age ± SD 72 ± 10 years were the study population. Overall, PAF was detected in 43.9% of patients. PAF detection increased from 18.75% of patients with Brown ESUS-AF score 0 to 54.3% of patients with Brown ESUS-AF score ≥ 2. PAF was detected in 37.2% of patients with AS5F < 67.5 and 51.2% of patients with AS5F score ≥ 67.5. AUROC of Brown ESUS-AF score in predicting AF detection was 0.642 (95% CI: 0.528-0.745), while AUROC of AS5F was 0.618 (95% CI: 0.504-0.723)(p=0.6872). No difference between predictive power of Brown ESUS-AF and AS5F scores with CHA2DS2-VASc (AUROC 0.671, 95% CI: 0.559-0.771) was found. Conclusion: Both Brown ESUS-AF and AS5F scores could be used as a screening tool for selecting ESUS patients requiring prolonged ECG monitoring aimed to detect PAF. However, in our study their predictive power was quite low and not superior to that of CHA2DS2-VASc score.