Evidence map›Paper›PMID 31511980›Full record

Observational studyJournal of neurology2019

MR-imaging pattern is not a predictor of occult atrial fibrillation in patients with cryptogenic stroke.

C Vollmuth, S Stoesser, H Neugebauer, A Hansel, J Dreyhaupt, A C Ludolph, J Kassubek, K Althaus

Erratum issuedOpen access · hybridAbstract readComparative StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Journal of neurology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 9 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 1 pooled it
1.3field-weighted citation impact, top 18% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 1 synthesis or guideline pooled it, 15 citations in OpenAlex.

  1. Pooled it
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  3. Observational
  4. Review
  5. Article
  6. Article
  7. Article
  8. Article
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors at 2 institutions in 1 country.

C VollmuthDepartment of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
S StoesserDepartment of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
H NeugebauerDepartment of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
A HanselDepartment of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
J DreyhauptInstitute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.
A C LudolphDepartment of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
J KassubekDepartment of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
K AlthausDepartment of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany. katharina.althaus@uni-ulm.de.ORCID http://orcid.org/0000-0002-9004-4335
Universität Ulm · DEUniversity of Bonn · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTo date, insertable cardiac monitors (ICMs) are the most effective method for the detection of occult atrial fibrillation (AF) in cryptogenic stroke. The overall detection rate after 12 months, however, is low and ranges between 12.4 and 33.3%, even if clinical predictors are considered. Ischemic stroke patients due to cardiogenic embolism present with particular lesion patterns. In patients with cryptogenic stroke, MR-imaging pattern may be a valuable predictor for AF.

methodsThis is an MRI-based, retrospective, observational, comparative, single-center study of 104 patients who underwent ICM implantation after cryptogenic stroke. The findings were compared to a reference group with related stroke etiology, i.e., 166 patients with embolic stroke due to AF detected for the first time by long-term ECG. Lesion patterns were evaluated with regard to affected territories, distribution (cortical, lacunar, scattered), lesion volume, and lesion size (diameter of the lesion size > 20 mm).

resultsThe MR-imaging analysis of acute ischemic lesions yielded no association between AF and lesion size or volume, arterial vessel distribution, or the number of affected territories. There was no significant difference between the cohorts regarding ischemic patterns (cortical lesions, scattered lesions, and lacunar infarcts). An important clinical inference of our findings is that 10% (2 of 20) of cases in the ICM group in whom AF was detected had a lacunar infarct pattern. Similar results were shown in cases of ischemic stroke patients with AF detected for the first time by long-term ECG, with 10.9% (16 of 147) of them showing lacunar infarcts. The analysis of chronic MRI lesions revealed no differences between the groups in the rate of chronic lesions, arterial vessel distribution, or the number of affected territories. Left atrial size (LA size) and the presence of atrial runs in long-term ECG were independently associated with AF.

conclusionsIn this MRI-based analysis of patients with cryptogenic stroke who had received ICM implantation, the detection rate of AF in patients with ICM was not related to the imaging pattern. In addition, the lacunar infarct pattern should not be an exclusion criterion for ICM insertion in patients with cryptogenic stroke. ICM insertion in patients with cryptogenic stroke should not be evaluated solely on the basis of reference to infarct patterns.

Indexed as

Magnetic Resonance ImagingAgedAged, 80 and overAtrial FibrillationElectrocardiography, AmbulatoryFemaleHumansIschemic Attack, TransientMaleMiddle AgedRetrospective StudiesStrokeStroke, LacunarCryptogenic strokeInsertable cardiac monitorMagnetic resonance imaging

Identifiers

PMID31511980
PMCPMC6851041
OpenAlexW2972824649

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.