A Simplified Risk Score to Predict In-Hospital Newly-Diagnosed Atrial Fibrillation in Acute Ischemic Stroke Patients

Figures & data

Figure 1 Study flow chart and patient selection procedure.

Figure 2 P-wave terminal force in lead V1 (PTFV1) measurement by WebPlotDigitizer (A) 12-lead echocardiography with PTFV1, (B) X and Y axes calibration, and (C) acquired data and PTFV1 calculation. PTFV1 = 5000 µV msec.

Figure 3 P-wave dispersion (PWD) measurement by WebPlotDigitizer (A) 12-lead electrocardiography with PWD, (B and C) axes calibration and acquired data to measure maximal and minimal P wave duration, respectively. PWD = 115 msec.

Table 1 Baseline Characteristics of the Patients

Characteristics	Total Cohort (n = 244)	NDAF (n = 52)	No NDAF (n = 192)	P-value
Demographic
Age, yr – mean (SD)	66.1 (14.5)	74.6 (10.6)	63.8 (14.5)	<0.001
Male sex – no. (%)	126 (51.9)	19 (36.5)	107 (56.0)	0.013
BMI, kg/m^2 – mean (SD)	24.4 (4.3)	24.6 (4.9)	24.4 (4.2)	0.85
Current smoking – no. (%)	30 (12.3)	6 (11.5)	24 (12.5)	0.85
Current alcohol drinking – no. (%)	58 (23.8)	8 (15.4)	50 (26.0)	0.11
SBP, mmHg – mean (SD)	155.0 (30.6)	155.2 (32.2)	155.0 (30.3)	0.98
Heart rate, bpm – mean (SD)	83.9 (17.5)	79.8 (15.2)	85.0 (18.0)	0.05
Admission NIHSS – median (IQR)	12.5 (5–19.5)	16 (10.5–21)	11 (4–18)	0.001
Admission mRS – median (IQR)	4 (3–5)	4 (4–5)	4 (3–5)	0.21
Time to NDAF detection, days – median (IQR)	2 (1–3.5)	2 (1–3.5)	NA	NA
Medical history – no. (%)
Hypertension	152 (62.3)	37 (71.2)	115 (59.9)	0.14
Diabetes mellitus	76 (31.2)	19 (36.5)	57 (29.7)	0.34
Dyslipidemia	82 (33.6)	18 (34.6)	63 (33.3)	0.86
Coronary artery disease	19 (7.8)	6 (11.5)	13 (6.8)	0.26
Chronic kidney disease	17 (7.0)	4 (7.7)	13 (6.8)	0.76
Prior stroke/TIA	24 (9.8)	5 (9.6)	19 (9.9)	0.95
Laboratory results
Hemoglobin, g/dL – mean (SD)	13.1 (2.3)	12.4 (2.0)	13.3 (2.4)	0.009
Creatinine, mg/dL – median (IQR)	0.94 (0.74–1.18)	0.99 (0.73–1.16)	0.93 (0.74–1.18)	0.71
Fasting blood glucose, mg/dL – median (IQR)	126.5 (107–170.5)	126 (104–174)	127 (107–170)	0.89
HDL-C, mg/dL – mean (SD)	48.7 (15.2)	51.6 (17.6)	48.0 (14.5)	0.25
LDL-C, mg/dL – mean (SD)	112.8 (46.6)	95.3 (29.7)	117.1 (49.0)	0.02

Abbreviations: BMI, body mass index; HDL-C, high-density lipoprotein cholesterol; IQR, interquartile range; LDL-C, low-density lipoprotein cholesterol; mRS, modified Rankin Scale; NA, not applicable; NDAF, newly diagnosed atrial fibrillation; NIHSS, National Institute of Health Stroke Scale; SBP, systolic blood pressure; SD, standard deviation; TIA, transient ischemic attack.

Table 2 Cardiac Biomarkers, Electrocardiography, Echocardiography, and Neuroimaging Parameters of the Patients

Parameters	Total Cohort (n = 244)	NDAF (n = 52)	No NDAF (n = 192)	P-value
Cardiac markers
hs-TnT, ng/L – median (IQR)	13.4 (8.2–26.5)	17.0 (11.5–47.4)	13 (7.2–25.4)	0.03
PTFV1^†, µV·msec – median (IQR)	2000 (1000–3600)	2000 (1000–3600)	2000 (1040–3720)	0.78
PWD^‡, msec – median (IQR)	40 (20–60)	40 (30–60)	40 (20–60)	0.21
LADM, mm – mean (SD)	36.4 (7.8)	39.9 (7.7)	35.0 (7.5)	<0.001
LVEF, % – mean (SD)	62.9 (13.8)	60.7 (13.0)	63.7 (14.0)	0.24
Cardio-thoracic ratio – mean (SD)	57.7 (6.4)	61.0 (6.7)	56.9 (6.1)	<0.001
Neuroimaging – no. (%)
HMCAS/MCA dot sign	121 (49.8)	35 (67.3)	86 (45.0)	0.004
Cortical lesion	75 (30.9)	20 (38.5)	55 (28.8)	0.18
Scatter lesions				0.81
Bilateral hemisphere	20 (8.2)	4 (7.7)	16 (8.4)
Anterior-posterior	9 (3.7)	2 (3.9)	7 (3.7)
Mixed	25 (10.3)	7 (13.5)	18 (9.4)
Hemorrhagic transformation				0.03
Hemorrhagic infarction	26 (10.7)	7 (13.5)	19 (10.0)
Parenchymal hemorrhage	9 (3.7)	5 (9.6)	4 (2.1)

Notes: ^†PTFV1 is calculated by multiplying the duration (msec) and the depth (μV) of the downward deflection (terminal portion) of the P-wave in lead V1. ^‡PWD is defined as the difference between the widest and the narrowest P-wave duration (msec) recorded from the 12 ECG leads.

Abbreviations: HMCAS, hyperdense middle cerebral artery sign; hs-TnT, high-sensitivity troponin T; IQR, interquartile range; LADM, left atrial diameter; LVEF, left ventricular ejection fraction; MCA, middle cerebral artery; NDAF, newly diagnosed atrial fibrillation; PTFV1, P-wave terminal force in lead V1; PWD, P-wave dispersion; SD, standard deviation.

Table 3 Univariable Analysis

Variables	uOR	95% CI	P-value
Age ≥75 years	3.33	1.68–6.60	<0.001
Female sex	2.21	1.13–4.42	0.02
Current alcohol drinking	0.52	0.20–1.21	0.14
Heart rate >100 bpm	0.33	0.06–1.13	0.07
Admission NIHSS ≥8	2.93	1.30–7.24	0.005
Hypertension	1.65	0.82–3.46	0.15
Hemoglobin ≥13 g/dL	0.30	0.15–0.61	<0.001
HMCAS/MCA dot sign	2.51	1.26–5.12	0.005
Hemorrhagic transformation	2.19	0.91–5.04	0.07

Abbreviations: CI, confidence interval; HMCAS, hyperdense middle cerebral artery sign; MCA, middle cerebral artery; NIHSS, National Institute of Health Stroke Scale; uOR, unadjusted odds ratio.

Table 4 Multivariable Analysis

Variables	aOR	95% CI	P-value
Age ≥75 years	2.99	1.51–5.91	0.002
Female sex	2.08	1.04–4.14	0.04
Admission NIHSS	1.04	1.00–1.09	0.05
HMCAS/MCA dot sign	2.33	1.13–4.79	0.02

Abbreviations: aOR, adjusted odds ratio; CI, confidence interval; HMCAS, hyperdense middle cerebral artery sign; MCA, middle cerebral artery; NIHSS, National Institute of Health Stroke Scale.

Table 5 Significant Predictors and Assigned Item Scores for In-Hospital Newly Diagnosed Atrial Fibrillation

Predictors	Category	aOR (95% CI)	Coefficient	P-value	Assigned Score
Age	≥75 years	2.99 (1.51–5.91)	1.040604	0.003	1
	<75 years	Reference
Sex	Female	2.08 (1.04–4.14)	0.7486122	0.033	1
	Male	Reference
Admission NIHSS	≥8 points	2.05 (0.88–4.74)	0.7155069	0.049	1
	0–7 points	Reference
HMCAS/MCA dot sign	Yes	2.33 (1.13–4.79)	0.8962803	0.014	1
	No	Reference

Abbreviations: aOR, adjusted Odds ratio; CI, confidence interval; HMCAS, hyperdense middle cerebral artery sign; MCA, middle cerebral artery; NIHSS, National Institute of Health Stroke Scale.

Figure 4 Area under receiver operating characteristics (AuROC) curve.