Abstract 13902: Using CHADS2 Score “Backwards” plus Echo Abnormalities Suggests Occult Undiagnosed Atrial Fibrillation in 63% of Cryptogenic Stroke Patients
Introduction: Various clinical schema have been devised to predict which pts with atrial fibrillation (Afib) would benefit from warfarin anticoagulation to prevent strokes. One of the most accepted has been the CHADS2 score (CHF, hypertension, age>74, diabetes, stroke × 2). By adding echo abnormalities (LA>/=4, LV>/=5.6, ejection fraction<50%) to CHADS2=/>2 prior to stroke we were able to predict stroke in 97.5% of 243 stroke pts with documented Afib (95% confidence limits 95.6, 99.5). We hypothetised that by assessing the presence of these abnormalities in pts with cryptogenic stroke we might identify pts with occult intermittent Afib as the cause for their stroke.
Methods:From 1633 pts with ischemic stroke admitted from 2003–2008 we identified 169 pts with cryptogenic stroke; i.e. no documented atrial fibrillation, no carotid lesions and, on TEE, no evidence of atrial or ventricular clots, no patent foramen ovale, and no lesions in the ascending aorta. To determine if undiagnosed occult intermittent Afib might have played a role in the etiology of their stroke, the CHADS2 score and the presence of echo abnormalities prior to stroke in the cryptogenic stroke pts was tallied, using these parameters “backwards” to identify which cryptogenic stroke pts might have had intermittent occult Afib..
Results: CHADS2 score was >/= 2 in 94 cryptogenic stroke pts (55.6%, 95% confidence limits, 48.1, 63.1). Among 168 cryptogenic stroke pts with 2D echo data, 57 had abnormalities (33.9%, CL 26.8, 41.1) including 40 with LAE, 32 with LVE and 38 with low ejection fraction. Of the 168 pts with both CHADS2 and 2D echo data 106 pts (63.1%, CL 55.8, 70.4) had either or both CHADS2>/=2 and echo abnormalities.
Conclusion: The high incidence of CHADS2>/=2 prior to stroke and/or echo abnormalities found in these pts with cryptogenic stroke suggests that undiagnosed occult intermittent Afib might be quite common among pts with cryptogenic stroke. Using CHADS2 “ backwards” and echocardiographic abnormalities might identify which pts with cryptogenic stroke would be appropriate for long term event monitoring to diagnose intermittent Afib as the etiology of their stroke so anticoagulation could be instituted to prevent further strokes.
- © 2010 by American Heart Association, Inc.