risk of stroke (CVA) in atrial fibrillation (AF)

Last edited 10/2021 and last reviewed 10/2021

The determination of echocardiographic and clinical risk factors in a patient permit risk stratification:

Echocardiographic risk factors in patients with atrial fibrillation (1):

• global left ventricular dysfunction (relative risk 2.6)
• left atrial diameter 4.7-5.7 cm (relative risk 1.6)
• left atrial diameter > 5.7 cm (relative risk 2.7)

Clinical risk factors include (1,2):

• history of hypertension
• congestive heart failure within past three months
• diabetes mellitus
• previous stroke or transient ischaemic attack

The annual percentage incidence of stroke or thromboembolism may be stratified as follows (1):

• 1.0 for patients with no risk factors
• 6.0 for patients with one risk factor
• 18.6 for patients with two or three risk factors

A proportion of patients with embolic stroke of undetermined source (ESUS) have silent atrial fibrillation (AF) or develop AF after the initial evaluation (3):

• besides age as the most important variable, several other factors, including hypertension, higher body mass index, and lack of diabetes, are independent predictors of AF after ESUS
• when baseline NT-proBNP was available, only older age and elevation of this biomarker were predictive of subsequent AF

Reference:

• Lip, GYH. et al. The investigation and non-drug management of atrial fibrillation. BMJ 1995;311: 1562-5.
• The Practitioner 1999; 243:746-51.
• Bahit MC, Sacco RL, Easton JD, Meyerhoff J, Cronin L, Kleine E, Grauer C, Brueckmann M, Diener HC, Lopes RD, Brainin M, Lyrer P, Wachter R, Segura T, Granger CB. Predictors of Development of Atrial Fibrillation in Patients With Embolic Stroke Of Undetermined Source: An Analysis of the RE-SPECT ESUS Trial. Circulation. 2021 Oct 15. doi: 10.1161/CIRCULATIONAHA.121.055176. Epub ahead of print. PMID: 34649459