Predictive Power of Brown Esus-Af Score for Detection of Post Stroke Atrial Fibrillation: A Brief Report from Real World
Elisa Grifoni, Giulia Baldini, Mariella Baldini, Gabriele Pinto, Elisa Maria Madonia, Irene Micheletti, Eleonora Cosentino, Alessandro Dei, Ira Signorini, Maria Letizia Bartolozzi, Elisabetta Bertini, Sara Giannoni, Mattia Fonderico, Leonello Guidi, Attilio Del Rosso, Luca Masotti.
Introduction: Searching paroxysmal atrial fibrillation (PAF) is the cornerstone in post embolic stroke of undetermined source (ESUS) patients. The Brown ESUS-AF score was proposed as a simple and good prognosticator of poststroke PAF detection. Age (≥ 75 years 2 points, 65-74 years 1 point) and moderate-severe left atrial enlargement (LAE, 2 points) are the variables enclosed in the score. External validation of Brown ESUS-AF score was the aim of the present study. Materials and Methods: We analyzed demographic, clinical, trans-thoracic echocardiography and brain computer tomography characteristics of patients with ESUS undergone to two weeks external ECG monitoring after hospital discharge. PAF was considered detected when any evidence of AF and/or atrial flutter occurred at monitoring. Results: Eighty-two consecutive ESUS patients with mean age ± SD 72 ± 10 years were the study population. PAF detection increased from 18.75% of patients with Brown ESUS-AF score 0 to 54.3% of patients with Brown ESUS-AF score ≥ 2. AUC of Brown ESUS-AF score in predicting AF detection was 0.642 (95% CI: 0.528-0.745). No difference between predictive power of Brown ESUS-AF score and CHA2DS2-VASc score was found. Conclusion: Brown ESUS-AF score could be used as a screening tool for selecting ESUS patients requiring prolonged ECG monitoring aimed to detect PAF. However, in our study the predictive power of Brown ESUS-AF score was not superior to that of CHA2DS2-VASc score.View pdf