Identifying the cause of ischemic stroke is challenging, with 20-30% of cases classified as cryptogenic after extensive evaluation, leaving patients at higher risk of recurrence. PAF is a key cause, and detecting it is crucial for initiating anticoagulation to prevent recurrence. Atrial cardiomyopathy, even without atrial fibrillation, may be a primary factor in stroke through its prothrombotic properties.
A prospective study (October 2023 to March 2024) was conducted at neurology’s department of Habib Bourguiba University hospital and cardiology’s department of Hedi Chaker University hospital of Sfax, enrolling consecutive patients with acute ischemic stroke or transient ischemic attack. Patients were classified as cardioembolic, non-cardioembolic, or cryptogenic. A new PAF predictive score was developed using multivariate logistic regression and validated internally and externally.
The outcomes in 189 patients with mean age 65.02 (± 12.26) years were analyzed. The study developed ES2CRYP score, the first predictive score for PAF in stroke patients in Tunisia which integrated clinical features (elderly ≥ 75 years, female sex, coronary artery disease), P wave parameters (P wave dispersion and P-terminal force in V1 ≥ 3100 ms*µv), High burden of premature atrial contraction (PAC ≥ 400) and impaired left atrial strain (PALS ≤ 26.5). Patients with cryptogenic stroke after an exhaustive etiological investigation with a score ES2CRYP≥ 6 should be intensively screened for PAF and we consider that the indication for anticoagulation may be reasonable. ES2CRYP score showed an AUC of 0.920 in our external population.
The ES2CRYP score allow for personalized strategies, improving stroke patients’ phenotyping and optimizing cardiac workup and treatment for cryptogenic stroke patients at higher risk of PAF.