Clinical and Biomarker Determinants for Recurrent Stroke in Patients With Atrial Fibrillation
Rebecca Y. M. Cheung, M. Foley, David Bradley, Tim Cassidy, Rónán Collins, Simon Cronin, Eamon Dolan, Sarah Gorey, Kayvan Khadjooi, Isuru Induruwa, Mira Katan, Margaret O’Connor, Martin O’Donnell, Pádraig Synnott, David Williams, Annaelle Zietz, Peter J. Kelly, John McCabe
Abstract
BACKGROUND AND OBJECTIVES: Despite effective secondary prevention, including oral anticoagulant (OAC) therapy, the risk of recurrent stroke (RS) in patients with atrial fibrillation (AF) remains substantial with an annualized risk of 3.2%-6.5% per year. The reasons for this high residual risk are unclear. There is growing need for improved risk prediction tools to identify patients at greatest risk of RS in AF and to find new therapeutic targets for secondary prevention. Our objective was to perform a systematic review to investigate the association of clinical factors and echocardiographic, blood, and neuroimaging biomarkers, with stroke recurrence after AF-related stroke. METHODS: We searched Embase/Ovid Medline until August 2023. Studies were included irrespective of OAC use. Risk ratios (RRs) were pooled using random effects. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. RESULTS: ), intracardiac thrombus (RR 1.99, 1.38-2.87), spontaneous left atrial appendage (LAA) echocardiographic contrast (RR 2.91, 1.21-6.17), or low LAA intensity variation (RR 2.81, 1.48-5.32). Data were limited for blood biomarkers. DISCUSSION: We identified several clinical factors associated with recurrence after AF-related stroke, with AF burden and stroke despite OAC of particular clinical relevance. Biomarkers of atrial cardiopathy, small vessel disease, or previous infarction were also associated with RS. Collaborative efforts are needed to identify and validate new risk factors and biomarkers of RS in AF.