Some patients who have an embolic stroke of undetermined source (ESUS) are especially vulnerable to developing atrial fibrillation (AF), a recent study has found.
AF is a heart condition that causes an irregular heartbeat and abnormally fast heart rate and is a factor into up to one in five strokes in the UK.
RE-SPECT ESUS was a randomised, controlled trial (RCT) assessing dabigatran versus aspirin to prevent recurrent stroke for people with ESUS.
AF incidence was not part of the main study. The condition was either reported as an adverse event, found on cardiac monitoring or listed on case reports for recurrent stroke.
A total of 5390 patients were enrolled across 564 sites in 42 countries.
Just 7.5 per cent of the participants enrolled in the study were identified as having AF over a median follow-up of 19 months. However, those with the condition were at increased risk of having another stroke.
The annualised rate of stroke recurrence was nearly twice as high among this group. Stroke risk was also higher among patients with more risk factors revealed in the study.
The researchers concluded: “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.
“Understanding who is at higher risk of developing AF will assist in identifying patients who may benefit from more intense, long-term cardiac monitoring.”
George Ntaios, MD, PhD of the University of Thessaly, Greece, stressed that the role of long-term cardiac monitoring to reduce the risk of stroke had not yet been established.
Ntaios also noted that there was no evidence to suggest that stroke risk could be reduced with an AF-detection strategy using NT-proBNP blood tests which measure brain natriuretic peptide to detect heart failure.
The researcher said that it was worth exploring “whether we need to anticoagulate subclinical episodes of atrial fibrillation in patients with ESUS, especially those episodes who have short duration and occur distally from the time of stroke.”
The term ‘ESUS’ was developed in 2014 and identifies ischemic stroke with an unknown origin.
According to a 2017 literature review, ESUS accounts for one in sixischemic strokes.
Patients with ESUS tend to be younger than those typically affected by stroke and their strokes tend to be mild. However, ESUS is associated with a relatively high recurrence rate.
