Abstract：
BACKGROUND: Whether specific imaging aspects can be used to identify cryptogenic stroke (CS) patients with high risk of underlying atrial fibrillation (AF) remains unclear. The purpose of this study was to evaluate brain-imaging features in CS patients and their utility as AF predictors.
METHODS: The Nordic Atrial Fibrillation and Stroke study was a prospective observational study of CS and transient ischemic attack patients undergoing 12-month cardiac-rhythm monitoring, biomarker and clinical assessments. In this imaging sub-study, brain magnetic resonance imaging and computed tomography scans from 106 patients were assessed for acute and chronic ischemic lesions in relation to AF occurrence and included in a score to predict AF. Receiver operating characteristics (ROC) curve was used to evaluate the discriminative ability of the score and for its dichotomization for predictive model.
RESULTS: Age, periventricular white-matter hyperintensities (PVWMH), acute lesion size, and vessel occlusion were significantly associated with AF. Acute and chronic cortical infarcts as well as chronic cerebellar infarcts were numerically more frequent in the AF group than the non-AF group. A score consisting of six features (0-6 points) was proposed (age ≥ 65 years, chronic cortical or cerebellar lesions, acute cortical lesions, PVWMH ≥ 2 in Fazekas scale, vessel occlusion, and acute lesion size ≥ 10 mm). Area under ROC curve was 0.735 and a score of ≥ 3 points was a predictor of AF.
CONCLUSIONS: The suggested score was shown to identify CS patients with an increased risk of underlying AF.
METHODS: The Nordic Atrial Fibrillation and Stroke study was a prospective observational study of CS and transient ischemic attack patients undergoing 12-month cardiac-rhythm monitoring, biomarker and clinical assessments. In this imaging sub-study, brain magnetic resonance imaging and computed tomography scans from 106 patients were assessed for acute and chronic ischemic lesions in relation to AF occurrence and included in a score to predict AF. Receiver operating characteristics (ROC) curve was used to evaluate the discriminative ability of the score and for its dichotomization for predictive model.
RESULTS: Age, periventricular white-matter hyperintensities (PVWMH), acute lesion size, and vessel occlusion were significantly associated with AF. Acute and chronic cortical infarcts as well as chronic cerebellar infarcts were numerically more frequent in the AF group than the non-AF group. A score consisting of six features (0-6 points) was proposed (age ≥ 65 years, chronic cortical or cerebellar lesions, acute cortical lesions, PVWMH ≥ 2 in Fazekas scale, vessel occlusion, and acute lesion size ≥ 10 mm). Area under ROC curve was 0.735 and a score of ≥ 3 points was a predictor of AF.
CONCLUSIONS: The suggested score was shown to identify CS patients with an increased risk of underlying AF.
摘要：
背景：是否可以使用特定的影像学检查来识别潜在房颤（AF）高风险的隐源性卒中（CS）患者尚不清楚。这项研究的目的是评估CS患者的脑影像学特征及其作为AF预测因子的效用。
方法：北欧心房颤动和卒中研究是一项前瞻性观察性研究，对接受12个月心律监测的CS和短暂性脑缺血发作患者，生物标志物和临床评估。在这项成像子研究中，我们对106例患者的脑磁共振成像和计算机断层扫描进行了急性和慢性缺血性病变与AF发生的关系评估,并将其纳入预测AF的评分中.受试者工作特征（ROC）曲线用于评估评分的判别能力及其对预测模型的二分法。
结果：年龄，脑室周围白质高信号（PVWMH），急性病变大小，血管闭塞与房颤显著相关。AF组的急性和慢性皮质梗塞以及慢性小脑梗塞的发生率高于非AF组。提出了由六个特征组成的分数（0-6分）（年龄≥65岁，慢性皮质或小脑病变，急性皮质病变,Fazekas量表中的PVWMH≥2，血管闭塞,和急性病变大小≥10mm)。ROC曲线下面积为0.735，≥3分是房颤的预测因子。
结论：建议的评分显示可确定CS患者的潜在房颤风险增加。
方法：北欧心房颤动和卒中研究是一项前瞻性观察性研究，对接受12个月心律监测的CS和短暂性脑缺血发作患者，生物标志物和临床评估。在这项成像子研究中，我们对106例患者的脑磁共振成像和计算机断层扫描进行了急性和慢性缺血性病变与AF发生的关系评估,并将其纳入预测AF的评分中.受试者工作特征（ROC）曲线用于评估评分的判别能力及其对预测模型的二分法。
结果：年龄，脑室周围白质高信号（PVWMH），急性病变大小，血管闭塞与房颤显著相关。AF组的急性和慢性皮质梗塞以及慢性小脑梗塞的发生率高于非AF组。提出了由六个特征组成的分数（0-6分）（年龄≥65岁，慢性皮质或小脑病变，急性皮质病变,Fazekas量表中的PVWMH≥2，血管闭塞,和急性病变大小≥10mm)。ROC曲线下面积为0.735，≥3分是房颤的预测因子。
结论：建议的评分显示可确定CS患者的潜在房颤风险增加。
