Kneihsl et al reported a simple score to predict the presence of atrial fibrillation in a patient with a cryptogenic stroke. The authors are from the Medical University of Graz.
Parameters:
(1) age in years
(2) brain imaging
(3) left ventricular ejection fraction (LVEF) in percent
(4) left atrial enlargement (presternal long-axis >= 45 mm OR apical long-axis >= 60 mm
(5) supraventricular premature beats
(6) atrial run
(7) NT-proBNP in pg/mL and ejection
Parameter
Finding
Points
age in years
< 60 years
0
60 to 75 years
1
>= 75 years
2
brain imaging
recurrent stroke on antiplatelet agents
1
multi-territory brain infarct
1
prior cortical or cerebellar infarction
2
none of these
0
LVEF
< 40%
2
40 to 50%
1
> 50%
0
left atrial enlargement
yes
2
no
0
supraventricular premature beats
present on baseline ECG
2
> 125 on 24-hour Holter
1
neither
0
atrial run
> 20 beats
2
<= 20 beats
0
NT pro-BNP
>= 505 pg/mL AND LVEF >= 50%
2
>= 505 pg/mL AND LVEF < 50%
1
< 505 pg/mL
0
total score =
= SUM(points for all of the parameters
Interpretation:
• minimum score: 0
• maximum score: 14 in theory (13 may be the max due to LVEF and NT pro-BNP)
• A score >= 4 has a sensitivity of 92% and specificity of 67% for 1-year prediction of AF.
Performance:
• The area under the ROC curve is 0.85.
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