STAF score is a new simple approach for diagnosing cardioembolic stroke

External Validation of SAFE Score to Predict Atrial Fibrillation Diagnosis after Ischemic Stroke: A Retrospective Multicenter Study

Introduction

The screening for atrial fibrillation (AF) scale (SAFE score) was recently developed to provide a prediction of the diagnosis of AF after an ischemic stroke. It includes 7 items: age ≥ 65 years, bronchopathy, thyroid disease, cortical location of stroke, intracranial large vessel occlusion, NT-ProBNP ≥250 pg/mL, and left atrial enlargement. In the internal validation, a good performance was obtained, with an AUC = 0.88 (95% CI 0.84-0.91) and sensitivity and specificity of 83% and 80%, respectively, for scores ≥ 5. The aim of this study is the external validation of the SAFE score in a multicenter cohort.

Methods

A retrospective multicenter study, including consecutive patients with ischemic stroke or transient ischemic attack between 2020 and 2022 with at least 24 hours of cardiac monitoring. Patients with previous AF or AF diagnosed on admission ECG were excluded.

Results

Overall, 395 patients were recruited for analysis. The SAFE score obtained an AUC = 0.822 (95% CI 0.778-0.866) with a sensitivity of 87.2%, a specificity of 65.4%, a positive predictive value of 44.1%, and a negative predictive value of 94.3% for a SAFE score ≥ 5, with no significant gender differences. Calibration analysis in the external cohort showed an absence of significant differences between the observed values and those predicted by the model (Hosmer-Lemeshow's test 0.089).

Conclusions

The SAFE score showed adequate discriminative ability and calibration, so its external validation is justified. Further validations in other external cohorts or specific subpopulations of stroke patients might be required.

Obesity-hyperlipidemia, Hypertension, and Left Atrial Enlargement During Stroke in Young Adults

BACKGROUND

This study investigated the association between left atrial enlargement and stroke severity in young adults. We also studied the differences between the normal and left atrial enlargement groups in clinical data.

METHODS

A total of 135 young stroke patients admitted to the Department of Neurology of the Taizhou People's Hospital were recruited from January 2018 to December 2021. The patients were divided into normal and enlarged groups by left atrial size. The relationship between the left atrial diameter and the National Institutes of Health Stroke Scale score was analyzed apart from the differences in clinical variables.

RESULTS

No relationship was observed between the left atrial diameter and the National Institutes of Health Stroke Scale score ( r =-0.045 P =0.603). The univariate analysis of both groups revealed that hypertension ( P =0.004), hyperlipidemia ( P =0.001), body mass index ( P =0.000), obesity ( P =0.015), and not stroke etiologic subtypes were associated with left atrial enlargement. In binary logistic regression analysis models, hyperlipidemia 3.384 (95% CI, 1.536 to 7.452), hypertension 2.661 (95% CI, 1.066 to 6.639), and obesity 2.858 (95% CI, 1.158 to 7.052) were significantly associated with the young stroke of left atrial enlargement.

CONCLUSIONS

In young adults, obesity-hyperlipidemia and hypertension were significantly associated with left atrial enlargement in stroke.

Factors influencing the outcome of cardiogenic cerebral embolism: a literature review

OBJECTIVE

The onset of cardiogenic cerebral embolism is sudden, dangerous, and often has high morbidity and mortality. Improving understanding of factors contributing to outcomes of cardiogenic cerebral embolism will improve prognostic and therapeutic capabilities.

METHODS

Through PubMed and Google Scholar, this paper examined and analyzed the factors implicated in the outcome of patients with cardiogenic cerebral embolism using the key terms 'cardiogenic cerebral embolism', 'atrial fibrillation', 'stroke related diseases', 'collateral circulation', 'emboli profile', 'epigenetic' up to 28 February 2021. Full texts of the retrieved articles were accessed. In general, in these literatures, National Institute Health of Stroke Scale (NIHSS) score ≥ 17, modified Rankin Scale (mRS) score ≥ 2, stroke recurrence, death caused by stroke are regarded as the criteria of poor prognosis. As long as one of these conditions occurs, it is judged as poor prognosis.

RESULTS

Factors influencing patient outcomes including patient outcome include severity of neurological impairment, types and severity of combined heart diseases, establishment of cerebral collateral circulation, treatments, components of emboli causing cardiogenic cerebral embolism, existence and control of other system complications, distribution and expression of inflammatory immune cells and molecules in the course of cardiogenic cerebral embolism, and epigenetic changes related to disease prognosis.

CONCLUSION

Regarding to prevention and treatment of cardiogenic cerebral embolism, the related factors, such as clinical setting, emboli pathological profile, and epigenetic changes should be emphasized so that outcomes and recurrence of cardiogenic cerebral embolism can be improvised.

Diagnostic accuracy of STAF, LADS, and iPAB scores for predicting paroxysmal atrial fibrillation in patients with acute cerebral infarction

BACKGROUND AND OBJECTIVE

The scoring scales scoring system for targeting atrial fibrillation (STAF), left atrial diameter, age, diagnosis of stroke, and smoking status (LADS), and identified by past history of arrhythmia or antiarrhythmic agent use, atrial dilation, and elevation of Brain natriuretic peptide (iPAB) have been proposed for predicting atrial fibrillation in patients with acute cerebral infarction, but their relative accuracies are not clear. This prospective study compared STAF, LADS, and iPAB scores for predicting paroxysmal atrial fibrillation (PAF) in patients with acute cerebral infarction.

METHODS

Patients with acute cerebral infarction (n = 744; 495 men, 249 women; aged 65 ± 12 years) were consecutively enrolled throughout the year 2016 at the Department of Neurology of Huizhou Municipal Central Hospital. Patients were followed for 3 months. The sensitivity, specificity, area under the receiver operating characteristic curve (AUC), and best cutoff points of STAF, LADS, and iPAB scores for predicting PAF were computed.

RESULTS

Among the 744 patients, 37 patients had PAF. The AUCs of the STAF, LADS, and iPAB scores for predicting PAF were 0.87, 0.79, and 0.84, respectively, and with a cutoff at four points, the sensitivities were 73%, 70.3%, and 83.8%, and specificities were 92.1%, 82.2%, and 77%.

CONCLUSIONS

The STAF, LADS, and iPAB scores could satisfactorily predict PAF in patients with acute cerebral infarction. STAF was superior to the others in diagnostic performance.

Diagnostic value of STAF score in combination with D-dimer in cardioembolism

The aim of this study was to evaluate the diagnostic value of the Score for the Targeting of Atrial Fibrillation (STAF) in combination with the serum D-dimer (DD) levels in cardioembolism(CE).This study was a retrospective case-onlystudy, consecutively including patients with acute ischemic stroke. All patients were evaluated following the STAF scoring criteria and were classified according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) etiology classification criteria. A total of 317 patients were enrolled, including 37 CE cases (11.67%). STAF ≥5 showed a sensitivity of 89% and a specificity of 91% for the diagnosis of CE, whereas DD >791.30 ng/mL had a sensitivity of 58% and a specificity of 78%. When the STAF was used in combination with the DD level, the sensitivity was 95%, and the specificity was 100%.STAF score is an excellent tool for the diagnosis of CE when combined with DD, and can facilitate the etiological classification of acute ischemic stroke.

Serum prealbumin as an effective prognostic indicator for determining clinical status and prognosis in patients with hemorrhagic stroke

Serum prealbumin is a recognized marker of malnutrition, but its prognostic role in patients with hemorrhagic stroke remains unclear. In this study, we retrospectively reviewed the records of 105 patients with hemorrhagic stroke admitted to Renmin Hospital of Wuhan University, China, from January to December 2015. We collected demographic and radiological data, and recorded serum prealbumin levels at admission and on days 1, 3, 6, 9, and 14–21. The existence of infections and gastrointestinal hemorrhage, and clinical condition at discharge were also recorded. Serum prealbumin levels during hospitalization were significantly lower in patients with infections compared with those without infections, and also significantly lower in patients with gastrointestinal hemorrhage compared with those without. Serum prealbumin levels at discharge were significantly higher in patients with good recovery than in those with poor recovery. We conclude that regular serum prealbumin measurements in patients with hemorrhagic stroke may be a useful indicator for determining clinical status and prognosis, which may therefore help to guide clinical decision-making.