Atrial fibrillation predictors in patients with embolic stroke of undetermined source

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"IntroductionIschemic stroke accounts for 85% of all types of stroke and is one of the main causes of morbidity and mortality in the general population.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> No underlying cause is identified in up to 20–40% of cases,<a class="elsevierStyleCrossRef" href="#bib0010">2</a> an etiology termed as cryptogenic stroke (CS). Most cases within this subtype are of embolic nature, which is why they are known as embolic stroke of undetermined source (ESUS), and atrial fibrillation (AF) is believed to be responsible for a significant percentage of these episodes.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>Treatment of ESUS in the absence of documented AF is based on antiplatelet therapy, despite which patients with this condition have a high rate of stroke recurrence of approximately 5% depending on the case series.<a class="elsevierStyleCrossRefs" href="#bib0020">4,5</a> In recent years, several studies<a class="elsevierStyleCrossRefs" href="#bib0030">6–8</a> have compared conventional antiplatelet therapy with direct-acting oral anticoagulants in patients with ESUS, failing to demonstrate the superiority of these drugs and even linking them to a higher risk of hemorrhage.<a class="elsevierStyleCrossRefs" href="#bib0030">6,7</a>Therefore, signs of AF should be actively searched by means of electrocardiographic monitoring,<a class="elsevierStyleCrossRef" href="#bib0045">9</a> although there is still no consensus on the ideal type and duration of such monitoring.<a class="elsevierStyleCrossRefs" href="#bib0050">10,11</a> The findings of the CRYSTAL-AF<a class="elsevierStyleCrossRef" href="#bib0010">2</a> study demonstrated that the detection of AF by a subcutaneous implantable Holter was superior to that of conventional 24-h Holter electrocardiogram (Holter-ECG) monitoring both 6 and 12 months after the event. The results of the EMBRACE study were similar,<a class="elsevierStyleCrossRef" href="#bib0060">12</a> as monitoring with a textile wearable Holter for 30 days resulted in a five-fold increase in the rate of AF detection compared with the conventional monitoring strategy. Despite the above, these devices are not widely used because of their high cost and limited availability in many healthcare centers, which makes it necessary to screen for AF predictors with a view to identify patients who would benefit the most from prolonged monitoring.In this context, different echocardiographic and electrocardiographic markers have been proposed as AF predictors in patients with ESUS. The most studied one is left atrial enlargement (LAE), as it has been shown to be a robust predictor of AF onset.<a class="elsevierStyleCrossRefs" href="#bib0065">13,14</a> Both LEA and atrial fibrosis have been proposed as a marker of a common pathological thrombogenic substrate, known as atrial cardiomyopathy, which could be the underlying cause of a significant percentage of cases of ESUS.<a class="elsevierStyleCrossRef" href="#bib0075">15</a>On the other hand, certain electrocardiographic markers, such as first-degree atrioventricular block (AVB)<a class="elsevierStyleCrossRef" href="#bib0080">16</a> and interatrial block (IAB),<a class="elsevierStyleCrossRefs" href="#bib0085">17,18</a> translate into the presence of a conduction delay secondary to atrial fibrosis, and could also be linked to a higher incidence of AF. Other authors have proposed that the ventricular repolarization measure, calculated based on the QT interval corrected for the patient’s heart rate (QTc), could also reflect an atrial pathophysiology.<a class="elsevierStyleCrossRefs" href="#bib0095">19,20</a> Finally, in patients with ESUS, atrial arrythmias, such as frequent atrial extrasystoles (AEs)<a class="elsevierStyleCrossRef" href="#bib0105">21</a> or bouts of atrial tachycardia,<a class="elsevierStyleCrossRef" href="#bib0110">22</a> have been defined by some authors as symptoms preceding an episode of AF.Thus, the main objective of our study is to analyze whether certain echocardiographic and electrocardiographic markers increase the likelihood of detecting AF during patient follow-up. Defining AF predictors in patients with ESUS would enable the selection of patients who are candidates for long-term monitoring and even the definition of a subgroup of patients at a high embolic risk as possible candidates for anticoagulation therapy.MethodsWe designed a single-center, retrospective, observational, cohort study in which patients with a diagnosis of ESUS admitted consecutively to a tertiary hospital throughout a 25-month period (November 2014 to December 2016) were included. All patients signed an informed consent form, and the protocol was approved by the hospital’s Ethics Committee.Patients and study groupsAn episode of ESUS was defined as the presence of a nonlacunar ischemic stroke detected by computed tomography (CT) or magnetic resonance imaging (MRI), without significant atheromatosis (≥50%) in the arteries of the infarcted territory, with no identified high-risk cardioembolic cause, and after having excluded other potential etiologies.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>The exclusion criteria were a diagnosis of AF, either prior to or during the patients’ hospital stay for ESUS, and the presence of high-risk cardioembolic sources, defined as: mechanical valve prostheses, intracardiac thrombus, acute myocardial infarction within the month prior to the event, dilated cardiomyopathy, infective endocarditis, atrial tumors, or rheumatic valve disease.The sociodemographic characteristics of all patients were included, and the CHA2DS2-VASc score was set as a potential predictor of AF.During their hospital stay, all patients underwent a 12-lead ECG, a Holter-ECG, and a transthoracic echocardiogram (TTE).Variables recorded in the analysis included demographic data; cardiovascular risk factors; electrocardiographic, echocardiographic, and 24-h Holter variables, which, according to the data published in the available literature, are associated with the onset of AF during follow-up, with only those with a p-value <0.1 being included in the multivariate analysis. All variables were determined prior to the data collection. Finally, the main variable studied was the appearance of AF during the patients’ two-year follow-up.The first ECG performed after each patient’s hospital admission was analyzed, collecting variables that could potentially increase the risk of developing AF, such as the presence of first-degree AVB (PR interval ≥200 ms), advanced interatrial block (A-IAB) (defined as a P wave ≥120 ms associated with a biphasic morphology in leads II, III, and aVF), and the QTc interval duration calculated using Bazett’s formula.The Holter-ECG allowed to record the following variables as predictors of AF: the presence of atrial tachycardia ≥20 beats and the presence of ≥1000 AEs in the 24-h Holter-ECG.The analyzed echocardiographic variables were the left atrial (LA) anteroposterior diameter, measured along the long parasternal axis (defining atrial enlargement as a diameter greater than 40 mm), as well as moderate-severe atrial enlargement with LA diameters ≥47 mm in men and ≥43 mm in women.The follow-up of each patient lasted 2-years, with the follow-up protocol involving the use of a Holter-ECG every 3 months throughout the first year and every 6 months throughout the second one. An additional symptom-guided Holter-ECG was also performed, and all visits to Emergency Departments and ECG reports available in each patient’s digital medical records during the follow-up period were reviewed.Atrial fibrillation during the followup was defined as the appearance of this type of arrhythmia in a surface ECG and those with a duration >30 s in a Holter-ECG.Two groups of patients were formed: group A included patients who did not experience AF during the follow-up and group B included those in which AF was detected. Variables of predictive value for the onset of the arrythmia were compared between both treatment arms, dividing them into the following three groups: clinical, electrocardiographic, or echocardiographic.Statistical analysisThe χ2 or Fisher’s exact test was used to compare quantitative variables. In the case of quantitative variables, Student’s T-test was used when the variables followed a normal distribution and the Mann-Whitney test was used when they did not. A p-value <0.05 was deemed significant. Variables related to an episode of AF within the 2 years following its onset (p < 0.1) were selected and compared by means of a multivariate logistic regression, whereby variables were selected by means of a stepped exclusion. The area under the receiver operating characteristic (ROC) curve of the logistic regression model was subsequently analyzed to predict the potential appearance of AF after 2 years, exclusively including variables that were identified as having a statistically significant association with the onset of AF in the multivariate analysis. Statistical software SPSS® (version 21.0, Chicago, USA) was used to analyze the results.ResultsA total of 95 patients, 71% of whom where men, were included in the study between November 2014 and December 2016. The mean age of these patients was 67.7 (11) years and their median CHA2DS2-VASc score was 2 <a class="elsevierStyleCrossRefs" href="#bib0005">[1–4]</a>.After a 24-month follow-up, AF was detected in 11 patients (11.6%), who were included in group B. Of these patients, three (27.2%) developed AF before 6 months, seven (63.6%) developed it before one year, and 100% developed it before 18 months, with no episode being detected between 18 and 24 months. With respect to the total population, the rate of AF detected was 3.2% at 6 months, 7.3% at one year, and 11.6% at 24 months.The mean time elapsed until the detection of an episode of AF was 11 (4.1) months.Both groups were comparable with respect to their baseline characteristics, except for their CHA2DS2-VASc score, which is considered a potential AF predictor. The baseline characteristics of both study groups are outlined in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Univariate analysisVariables that had been deemed potential AF predictors were compared between both groups (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> reflects the univariate and multivariate analyses.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>The median CHA2DS2-VASc score was greater in group B (4 [2–4]) compared with group A (2 [1–4]).In both groups, A-IAB was associated with an increased risk of developing AF (1.2% [n = 1] in group A versus 27.2% [n = 3] in group B; p = 0.004) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The onset of first-degree AVB, on the other hand, showed a nonstatistically significant trend (13.1% [n = 11] in group A versus 36.3% [n = 4] in group B; p = 0.06). However, no differences were observed in the QTc interval and the P wave between both groups.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>The number of AEs was slightly higher in group B than in group A (234 [75−1490] versus 91.5 [22−558], p = 0.13). The variable of presenting >1000 AEs within 24 h was also more frequent in the group of patients who developed AF during the followup (45.4% [n = 5] in group B versus 9.5% [n = 8] in group A; p = 0.006) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). In contrast, the occurrence of an episode of atrial tachycardia greater than 20 bpm was similar in both study groups.Neither the mean size of the LA nor the mean LAE within any range differed between both study groups (p = 0.2 and p = 0.3, respectively). However, the incidence of moderate or severe LAE was higher in the group of patients who developed AF (45.5% [n = 5] in group B versus 6% [n = 5] in group A; p = 0.002) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).Multivariate analysisValues that reached statistical significance in the multivariate analysis were firstdegree AVB (odds ratio [OR] = 7.2; p = 0.06), AIAB (OR = 12.8; p = 0.04), moderate or severe LAE (OR = 27.1; p = 0.02), and the occurrence of >1000 atrial extrasystoles (OR = 15; p = 0.01) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). This model offered a discrimination evaluated based on the area under the ROC curve of 0.9 [0.78−0.99] (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) to differentiate which patients developed AF at two years of follow-up.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>DiscussionAt present, there is much debate regarding the role of silent AF as the cause of CS due to the fact that this is a diagnosis of exclusion and, above all, due to the great heterogeneity of the literature available in relation to the patient profiles and the methods used to detect AF in the different studies performed.<a class="elsevierStyleCrossRef" href="#bib0115">23</a>It is noteworthy that AF detection rates vary greatly between different papers, even when the same ECG monitoring methods are used.<a class="elsevierStyleCrossRefs" href="#bib0010">2,12</a> Thus, depending on how selected the population to be monitored is, there will be a lower or greater likelihood of silent AF being identified as the cause of the CS. It is precisely for this reason that the concept of ESUS was introduced, i.e., to select a population in which AF is more likely to be responsible for the stroke. Similarly, the more exhaustive and extensive the screening for AF, the greater the likelihood of detecting it.<a class="elsevierStyleCrossRef" href="#bib0115">23</a>In our setting, despite the results of the CRYSTAL-AF<a class="elsevierStyleCrossRef" href="#bib0010">2</a> and EMBRACE studies,<a class="elsevierStyleCrossRef" href="#bib0060">12</a> most patients with ESUS are not monitored with an implantable or textile wearable Holter since the cost of these devices is very high. In fact, there are cost-effectiveness studies comparing different monitoring strategies applied following an ischemic stroke,<a class="elsevierStyleCrossRef" href="#bib0120">24</a> which conclude that both implantable devices and external monitoring for 30 days (external loop recorders) are not cost-effective.In this study, the rate of AF detection by a 24 h Holter-ECG was 11.6%, a much higher figure than that reported in other large studies using the same monitoring method.Patients included in the control arm of the CRYSTAL-AF study2 had a higher risk of developing AF than our cohort (CHADS score of 2.9 versus CHA2DS2-VASc score of 2), and they were subjected to in-person follow-up with the option of having a HolterECG study (at the Investigator’s discretion) performed every month after the event and subsequently every 6 months. Despite the above, the rate of AF detection was 1.4% at 6 months, 2.0% at 12 months, and 3.0% at 36 months, with the rates found in our study more than doubling these figures.These differences are most likely due to a better selection of the patients to be monitored (ESUS in our study versus CS in the CRYSTAL-AF study), as well as the closer follow-up carried out by us throughout the first year (every 3 months) and the systematic conduct of a Holter-ECG study during each consultation.In line with the findings of other authors,<a class="elsevierStyleCrossRefs" href="#bib0125">25,26</a> in our study, most episodes of AF were detected within the first 12 months. Furthermore, in our study, the cost-effectiveness of monitoring beyond 18 months was null, as no episodes of AF were detected between 18 and 24 months.Following the conduct of the different studies in which AF was proposed as the potential cause of up to 30% of ESUS,<a class="elsevierStyleCrossRef" href="#bib0110">22</a> some studies were designed to attempt to determine whether anticoagulant therapy with direct-acting oral anticoagulants in patients with ESUS reduced stroke reoccurrence.<a class="elsevierStyleCrossRefs" href="#bib0035">7,8</a> Their results demonstrated a clear lack of benefit of antiplatelet therapy and even a higher risk of hemorrhage associated with this treatment. Thus, it is essential to diagnose AF by ECG monitoring, as only these patients will benefit from this therapy.However, given that the percentage of patients with ESUS in whom AF is detected is limited, the search for AF predictors is very useful to select patients who would benefit the most from prolonged monitoring, considering its high cost and low availability.Both first-degree AVB and A-IAB have been described in the general population as markers of LA fibrosis and atrial remodeling,<a class="elsevierStyleCrossRef" href="#bib0085">17</a> and, therefore, of atrial electromechanical dysfunction, which predisposes patients to developing AF. In some studies,<a class="elsevierStyleCrossRefs" href="#bib0085">17,18</a> the presence of A-IAB in the general population doubles the risk of experiencing AF during the follow-up. In the study carried out by Mendieta et al. on 75 patients with ESUS,<a class="elsevierStyleCrossRef" href="#bib0135">27</a> A-IAB was the only independent predictor of AF during follow-up. The presence of first-degree AVB has been directly related to an increased risk of developing AF in both the general population and patients with CS.<a class="elsevierStyleCrossRefs" href="#bib0080">16,28</a> These findings were confirmed in our study, as our data showed that A-IAB behaves as an independent predictor of AF, while first-degree AVB showed a tendency to do so without reaching statistical significance, probably due to the small size of our study sample.In our cohort of 95 patients, AEs within the moderate range (>1000 AEs/24 h) behaved as a risk marker for developing AF in patients who experienced ESUS, which reaffirms the results of other studies, such as that performed by Gladstone et al.,<a class="elsevierStyleCrossRef" href="#bib0105">21</a> in which the percentage of AEs was the only independent predictor of AF in patients monitored for a prolonged period of time after a CS.Despite LAE being one of the parameters most closely related to the subsequent onset of AF,<a class="elsevierStyleCrossRef" href="#bib0145">29</a> while moderate or severe LAE did behave as a predictor of AF, mild LAE did not. Thus, although the relationship between the size of the LA and the onset of AF is very strong (a 30% increase in the LA is associated with a 43% likelihood of developing AF in the general population),<a class="elsevierStyleCrossRef" href="#bib0065">13</a> a high degree of enlargement is required.It is striking that mild LAE does not behave as a predictor of AF, while the previously mentioned electrical parameters do. Hence, these parameters could be early markers of an atrial disease that could be present at an incipient development phase of atrial fibrosis, prior to the occurrence of significant atrial enlargement. Therefore, according to our results, these electrical parameters are more sensitive when predicting AF than LAE, which needs to be moderate or severe to behave as a marker.In our study we identified three parameters that were independent predictors of the risk of developing AF (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), two of them electrical and one echocardiographic, and all of them easily identifiable by means of simple and highly available tests, such as an echocardiogram, a 12-lead ECG, or a 24-h Holter-ECG. Therefore, moderate or severe LAE, A-IAB, and a rate of >1000 AES in a 24-h Holter-ECG could be used as predictors in subsequent prospective studies in which patients with a high risk of developing AF after an ESUS would be monitored by means of an implantable Holter-ECG and establishing a risk scale for AF occurrence. In addition, they could play a role as markers of incipient atrial fibrosis when designing studies in which patients with ESUS who would benefit the most from anticoagulation therapy would be appropriately selected, as proposed in the ongoing ARCADIA study,<a class="elsevierStyleCrossRef" href="#bib0150">30</a> in which the use of apixaban versus antiplatelet therapy in patients with CS is being compared.This is a retrospective study with a small number of patients and, therefore, with the limitations inherent to said fact. However, it is true that consecutive cases have been included and that an exhaustive and long-term follow-up was carried out. The fact that patients were not monitored with an implantable Holter monitor may have underdetected some episodes of AF, although the intensive Holter monitoring of all patients detected AF in a high percentage of them.To conclude, moderate or severe LAE, A-IAB, and the presence of more than 1000 AEs in a 24-h Holter-ECG behaved as AF predictors in patients with ESUS. First-degree AVB also showed a trend to do so, albeit without reaching statistical significance.Conflicts of interestThe authors of this paper declare no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1632668" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1456824" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1632669" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Materiales y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1456825" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0010" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0015" "titulo" => "Methods" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Patients and study groups" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0030" "titulo" => "Results" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Univariate analysis" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Multivariate analysis" ] ] ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-05-16" "fechaAceptado" => "2020-09-06" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1456824" "palabras" => array:4 [ 0 => "Embolic stroke of undetermined source" 1 => "Atrial fibrillation" 2 => "Holter-electrocardiogram" 3 => "Predictors" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1456825" "palabras" => array:4 [ 0 => "Accidente cerebrovascular embólico de origen indeterminado" 1 => "Fibrilación auricular" 2 => "Holter-electrocardiograma" 3 => "Predictores" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Background and objectivesAtrial fibrillation (AF) detection in patients with embolic stroke of underdetermined source (ESUS), entails a change of medical treatment and a significant decrease in the incidence of new strokes. It is necessary to determine which patients would benefit more from prolonged electrocardiographic monitoring. Our aim was to find electrocardiographic and echocardiographic AF predictors in patients with ESUS. MethodsWe performed a cohort study that included 95 consecutive patients admitted to the hospital because of an ESUS. An electrocardiogram, each subject in the study underwent a 24-h Holter-electrocardiogram (Holter-ECG) and an echocardiogram. A 2-year follow up was also conducted, with a 24-h Holter-ECG every three months for the first year, and every 6 months during the second one. ResultsDuring the follow-up, AF was detected in 11 patients (11.6%), with a detection rate of 3.2% at 6 months, 7.4% at 12 months, and 11.6% at 18 months as well as at 24 months. The variables that were independently related to AF detection included moderate or severe left atrium dilation (p = .02), interatrial advanced block (p = .04) and more than 1000 premature atrial beats on 24 h Holter-ECG (p = .01). ConclusionsModerate or severe atrial dilation, interatrial advanced block, and the presence of more than 1000 premature atrial beats on 24 h Holter-ECG behave as AF predictors in patients with ESUS." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "Antecedentes y objetivosEn el accidente cerebrovascular embólico de origen indeterminado (ESUS), la detección de fibrilación auricular (FA) conlleva un cambio de tratamiento y una reducción drástica en la incidencia de nuevos ictus. Es necesario determinar qué pacientes se benefician en mayor medida de una monitorización electrocardiográfica prolongada. Nuestro objetivo fue la búsqueda de predictores electrocardiográficos y ecocardiográficos de FA en pacientes con ESUS. Materiales y métodosSe diseñó un estudio observacional de cohortes en el que se incluyeron 95 pacientes consecutivos que ingresaron por ESUS en un hospital terciario. A todos se les realizó un electrocardiograma (ECG), un Holter electrocardiograma (Holter-ECG) de 24 horas y un ecocardiograma durante el ingreso. Se realizó un seguimiento presencial durante dos años mediante Holter-ECG de 24 horas, trimestral durante el primer año y semestral durante el segundo. ResultadosDurante el seguimiento, se detectó FA en 11 pacientes (11,6%), siendo la tasa detección del 3,2% a los 6 meses, 7,4% a los 12 meses, y 11,6% a los 18 y a los 24 meses. Las variables que se relacionaron de forma independiente con el desarrollo de FA fueron la dilatación en grado moderado o severo de la aurícula izquierda (AI) (p = 002), el bloqueo interauricular avanzado (BIA-A) (p = 0,04), y la presencia de más de 1000 extrasístoles auriculares (EA) en Holter-ECG de 24 horas (p = 0,01). ConclusionesLa dilatación en un grado moderado o severo de AI, el BIA-A, y la presencia de más de 1000 EA en Holter-ECG de 24 horas se comportan como predictores independientes de FA en pacientes con ESUS." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Materiales y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Ramos-Maqueda J, Navarro-Valverde C, Esteve-Ruiz I, Cabrera-Ramos M, Rivera-López R, García-Medina D, et al. Predictores de fibrilación auricular en pacientes con ictus embólico de origen indeterminado. Med Clin (Barc). 2021;157:555–560." ] ] "multimedia" => array:5 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1816 "Ancho" => 2917 "Tamanyo" => 227892 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Bar graph representation of atrial fibrillation predictors: presence of more than 1000 atrial extrasystoles in a 24-h Holter-ECG, moderate or severe left atrial enlargement, and advanced interatrial block in an ECG in patients who experienced atrial fibrillation during the follow-up versus those who did not." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1524 "Ancho" => 1508 "Tamanyo" => 51127 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Area under the receiver operating characteristic (ROC) curve of the logistic regression model with respect to occurrence of AF at 2 years of follow-up." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "AF: atrial fibrillation; DLP: dyslipidemia; DM: diabetes mellitus; GFR: glomerular filtration rate; HBP: high blood pressure.Results are expressed as n (%), a mean (standard deviation), and a median [p25-p75]." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients’ baseline characteristics \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total patients (n = 95) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients in whom AF was not detected (n = 84) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients in whom AF was detected (n = 11) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67.7 (11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67.2 (11.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73.3 (7.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68 (71.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61 (72.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (63.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.54 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HBP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66 (69.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57 (67.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (81.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.49 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 (31.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 (32.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (27.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.52 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DLP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 (36.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32 (28.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (27.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.74 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Smoker \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 (27.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 (29.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (9.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.28 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GFR <60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (14.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (14.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (18.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.66 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GFR <90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 (22.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 (20.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (36.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.25 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2782134.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Main baseline characteristics of the total population and according to whether or not AF was detected during the follow-up." ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "AF: atrial fibrillation; A-IAB: advanced interatrial block; AVB: atrioventricular block; Holter-ECG: Holter electrocardiogram; LAE: left atrial enlargement.Results are expressed as n (%), a mean (standard deviation), and a median [p25–p75]." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients in whom AF was not detected (n = 84) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients in whom AF was detected (n = 11) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinical parameters \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CHA2DS2-VASc score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 [1–4] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 [2–4] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.04 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">[3.0] Electrocardiographic parameters</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P wave (ms) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 [80−120] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">120 [80−160] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">First-degree AVB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (13.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (36.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.06 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Corrected QT interval \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">403 (16.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">405.9 (28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A-IAB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (1.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (27.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.004 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">[2.0] 24-h Holter-ECG parameters</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Atrial tachycardia >20 beats \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (2.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (9.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Atrial extrasystoles \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91.5 [22−558] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">234 [75−1490] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.13 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>1000 atrial extrasystoles \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (9.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (45.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.006 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">[2.0] Echocardiographic parameters</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anteroposterior LA diameter (mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35.7 (5.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40.2 (8.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LAE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (26.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (45.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate LAE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (45.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2782133.png" ] ] ] ] "descripcion" => array:1 [ "en" => "AF predictors in patients according to whether or not AF was detected during the follow-up." ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "A-IAB: advanced interatrial block; AVB: atrioventricular block; LAE: left atrial enlargement; OR: odds ratio." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Predictors \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Univariate analysis OR \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Multivariate analysis OR \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CHA2DS2-VASc score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">First-degree AVB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.06 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.06 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A-IAB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.04 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate or severe LAE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.002 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>1000 atrial extrasystoles \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.006 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2782135.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Univariate and multivariate analysis of the main AF predictors." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Heart disease and stroke statistics—2020 update: a report from the American Heart Association" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.S. 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Atrial fibrillation predictors in patients with embolic stroke of undetermined source

Predictores de fibrilación auricular en pacientes con ictus embólico de origen indeterminado

Javier Ramos-Maquedaa,

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javierramosmaqueda@secardiologia.es

Corresponding author.

, Cristina Navarro-Valverdeb, Irene Esteve-Ruizb, Mercedes Cabrera-Ramosa, Ricardo Rivera-Lópezc, Dolores García-Medinab, Ricardo Pavón-Jiménezb, Francisco Javier Molano-Casimirob

a Servicio de Cardiología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain

b Servicio de Cardiología, Hospital Universitario Virgen de Valme, Sevilla, Spain

c Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain

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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Area under the receiver operating characteristic &#40;ROC&#41; curve of the logistic regression model with respect to occurrence of AF at 2 years of follow-up&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Ischemic stroke accounts for 85&#37; of all types of stroke and is one of the main causes of morbidity and mortality in the general population&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> No underlying cause is identified in up to 20&#8211;40&#37; of cases&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> an etiology termed as cryptogenic stroke &#40;CS&#41;&#46; Most cases within this subtype are of embolic nature&#44; which is why they are known as embolic stroke of undetermined source &#40;ESUS&#41;&#44; and atrial fibrillation &#40;AF&#41; is believed to be responsible for a significant percentage of these episodes&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Treatment of ESUS in the absence of documented AF is based on antiplatelet therapy&#44; despite which patients with this condition have a high rate of stroke recurrence of approximately 5&#37; depending on the case series&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> In recent years&#44; several studies<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;8</span></a> have compared conventional antiplatelet therapy with direct-acting oral anticoagulants in patients with ESUS&#44; failing to demonstrate the superiority of these drugs and even linking them to a higher risk of hemorrhage&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Therefore&#44; signs of AF should be actively searched by means of electrocardiographic monitoring&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> although there is still no consensus on the ideal type and duration of such monitoring&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a> The findings of the CRYSTAL-AF<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> study demonstrated that the detection of AF by a subcutaneous implantable Holter was superior to that of conventional 24-h Holter electrocardiogram &#40;Holter-ECG&#41; monitoring both 6 and 12 months after the event&#46; The results of the EMBRACE study were similar&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> as monitoring with a textile wearable Holter for 30 days resulted in a five-fold increase in the rate of AF detection compared with the conventional monitoring strategy&#46; Despite the above&#44; these devices are not widely used because of their high cost and limited availability in many healthcare centers&#44; which makes it necessary to screen for AF predictors with a view to identify patients who would benefit the most from prolonged monitoring&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In this context&#44; different echocardiographic and electrocardiographic markers have been proposed as AF predictors in patients with ESUS&#46; The most studied one is left atrial enlargement &#40;LAE&#41;&#44; as it has been shown to be a robust predictor of AF onset&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a> Both LEA and atrial fibrosis have been proposed as a marker of a common pathological thrombogenic substrate&#44; known as atrial cardiomyopathy&#44; which could be the underlying cause of a significant percentage of cases of ESUS&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">On the other hand&#44; certain electrocardiographic markers&#44; such as first-degree atrioventricular block &#40;AVB&#41;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> and interatrial block &#40;IAB&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a> translate into the presence of a conduction delay secondary to atrial fibrosis&#44; and could also be linked to a higher incidence of AF&#46; Other authors have proposed that the ventricular repolarization measure&#44; calculated based on the QT interval corrected for the patient&#8217;s heart rate &#40;QTc&#41;&#44; could also reflect an atrial pathophysiology&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a> Finally&#44; in patients with ESUS&#44; atrial arrythmias&#44; such as frequent atrial extrasystoles &#40;AEs&#41;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> or bouts of atrial tachycardia&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> have been defined by some authors as symptoms preceding an episode of AF&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Thus&#44; the main objective of our study is to analyze whether certain echocardiographic and electrocardiographic markers increase the likelihood of detecting AF during patient follow-up&#46; Defining AF predictors in patients with ESUS would enable the selection of patients who are candidates for long-term monitoring and even the definition of a subgroup of patients at a high embolic risk as possible candidates for anticoagulation therapy&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">We designed a single-center&#44; retrospective&#44; observational&#44; cohort study in which patients with a diagnosis of ESUS admitted consecutively to a tertiary hospital throughout a 25-month period &#40;November 2014 to December 2016&#41; were included&#46; All patients signed an informed consent form&#44; and the protocol was approved by the hospital&#8217;s Ethics Committee&#46;</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Patients and study groups</span><p id="par0040" class="elsevierStylePara elsevierViewall">An episode of ESUS was defined as the presence of a nonlacunar ischemic stroke detected by computed tomography &#40;CT&#41; or magnetic resonance imaging &#40;MRI&#41;&#44; without significant atheromatosis &#40;&#8805;50&#37;&#41; in the arteries of the infarcted territory&#44; with no identified high-risk cardioembolic cause&#44; and after having excluded other potential etiologies&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The exclusion criteria were a diagnosis of AF&#44; either prior to or during the patients&#8217; hospital stay for ESUS&#44; and the presence of high-risk cardioembolic sources&#44; defined as&#58; mechanical valve prostheses&#44; intracardiac thrombus&#44; acute myocardial infarction within the month prior to the event&#44; dilated cardiomyopathy&#44; infective endocarditis&#44; atrial tumors&#44; or rheumatic valve disease&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The sociodemographic characteristics of all patients were included&#44; and the CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc score was set as a potential predictor of AF&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">During their hospital stay&#44; all patients underwent a 12-lead ECG&#44; a Holter-ECG&#44; and a transthoracic echocardiogram &#40;TTE&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Variables recorded in the analysis included demographic data&#59; cardiovascular risk factors&#59; electrocardiographic&#44; echocardiographic&#44; and 24-h Holter variables&#44; which&#44; according to the data published in the available literature&#44; are associated with the onset of AF during follow-up&#44; with only those with a p-value &#60;0&#46;1 being included in the multivariate analysis&#46; All variables were determined prior to the data collection&#46; Finally&#44; the main variable studied was the appearance of AF during the patients&#8217; two-year follow-up&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The first ECG performed after each patient&#8217;s hospital admission was analyzed&#44; collecting variables that could potentially increase the risk of developing AF&#44; such as the presence of first-degree AVB &#40;PR interval &#8805;200&#160;ms&#41;&#44; advanced interatrial block &#40;A-IAB&#41; &#40;defined as a P wave &#8805;120&#160;ms associated with a biphasic morphology in leads II&#44; III&#44; and aVF&#41;&#44; and the QTc interval duration calculated using Bazett&#8217;s formula&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The Holter-ECG allowed to record the following variables as predictors of AF&#58; the presence of atrial tachycardia &#8805;20 beats and the presence of &#8805;1000 AEs in the 24-h Holter-ECG&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The analyzed echocardiographic variables were the left atrial &#40;LA&#41; anteroposterior diameter&#44; measured along the long parasternal axis &#40;defining atrial enlargement as a diameter greater than 40&#160;mm&#41;&#44; as well as moderate-severe atrial enlargement with LA diameters &#8805;47&#160;mm in men and &#8805;43&#160;mm in women&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The follow-up of each patient lasted 2-years&#44; with the follow-up protocol involving the use of a Holter-ECG every 3 months throughout the first year and every 6 months throughout the second one&#46; An additional symptom-guided Holter-ECG was also performed&#44; and all visits to Emergency Departments and ECG reports available in each patient&#8217;s digital medical records during the follow-up period were reviewed&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Atrial fibrillation during the followup was defined as the appearance of this type of arrhythmia in a surface ECG and those with a duration &#62;30&#160;s in a Holter-ECG&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Two groups of patients were formed&#58; group A included patients who did not experience AF during the follow-up and group B included those in which AF was detected&#46; Variables of predictive value for the onset of the arrythmia were compared between both treatment arms&#44; dividing them into the following three groups&#58; clinical&#44; electrocardiographic&#44; or echocardiographic&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0095" class="elsevierStylePara elsevierViewall">The &#967;<span class="elsevierStyleSup">2</span> or Fisher&#8217;s exact test was used to compare quantitative variables&#46; In the case of quantitative variables&#44; Student&#8217;s T-test was used when the variables followed a normal distribution and the Mann-Whitney test was used when they did not&#46; A p-value &#60;0&#46;05 was deemed significant&#46; Variables related to an episode of AF within the 2 years following its onset &#40;<span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;1&#41; were selected and compared by means of a multivariate logistic regression&#44; whereby variables were selected by means of a stepped exclusion&#46; The area under the receiver operating characteristic &#40;ROC&#41; curve of the logistic regression model was subsequently analyzed to predict the potential appearance of AF after 2 years&#44; exclusively including variables that were identified as having a statistically significant association with the onset of AF in the multivariate analysis&#46; Statistical software SPSS<span class="elsevierStyleBold">&#174;</span> &#40;version 21&#46;0&#44; Chicago&#44; USA&#41; was used to analyze the results&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0100" class="elsevierStylePara elsevierViewall">A total of 95 patients&#44; 71&#37; of whom where men&#44; were included in the study between November 2014 and December 2016&#46; The mean age of these patients was 67&#46;7 &#40;11&#41; years and their median CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc score was 2 <a class="elsevierStyleCrossRefs" href="#bib0005">&#91;1&#8211;4&#93;</a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">After a 24-month follow-up&#44; AF was detected in 11 patients &#40;11&#46;6&#37;&#41;&#44; who were included in group B&#46; Of these patients&#44; three &#40;27&#46;2&#37;&#41; developed AF before 6 months&#44; seven &#40;63&#46;6&#37;&#41; developed it before one year&#44; and 100&#37; developed it before 18 months&#44; with no episode being detected between 18 and 24 months&#46; With respect to the total population&#44; the rate of AF detected was 3&#46;2&#37; at 6 months&#44; 7&#46;3&#37; at one year&#44; and 11&#46;6&#37; at 24 months&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The mean time elapsed until the detection of an episode of AF was 11 &#40;4&#46;1&#41; months&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Both groups were comparable with respect to their baseline characteristics&#44; except for their CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc score&#44; which is considered a potential AF predictor&#46; The baseline characteristics of both study groups are outlined in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Univariate analysis</span><p id="par0120" class="elsevierStylePara elsevierViewall">Variables that had been deemed potential AF predictors were compared between both groups &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> reflects the univariate and multivariate analyses&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">The median CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc score was greater in group B &#40;4 &#91;2&#8211;4&#93;&#41; compared with group A &#40;2 &#91;1&#8211;4&#93;&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In both groups&#44; A-IAB was associated with an increased risk of developing AF &#40;1&#46;2&#37; &#91;n&#160;&#61;&#160;1&#93; in group A versus 27&#46;2&#37; &#91;n&#160;&#61;&#160;3&#93; in group B&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;004&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The onset of first-degree AVB&#44; on the other hand&#44; showed a nonstatistically significant trend &#40;13&#46;1&#37; &#91;n&#160;&#61;&#160;11&#93; in group A versus 36&#46;3&#37; &#91;n&#160;&#61;&#160;4&#93; in group B&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;06&#41;&#46; However&#44; no differences were observed in the QTc interval and the P wave between both groups&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">The number of AEs was slightly higher in group B than in group A &#40;234 &#91;75&#8722;1490&#93; versus 91&#46;5 &#91;22&#8722;558&#93;&#44; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;13&#41;&#46; The variable of presenting &#62;1000 AEs within 24 h was also more frequent in the group of patients who developed AF during the followup &#40;45&#46;4&#37; &#91;n&#160;&#61;&#160;5&#93; in group B versus 9&#46;5&#37; &#91;n&#160;&#61;&#160;8&#93; in group A&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;006&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; In contrast&#44; the occurrence of an episode of atrial tachycardia greater than 20 bpm was similar in both study groups&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Neither the mean size of the LA nor the mean LAE within any range differed between both study groups &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;2 and <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;3&#44; respectively&#41;&#46; However&#44; the incidence of moderate or severe LAE was higher in the group of patients who developed AF &#40;45&#46;5&#37; &#91;n&#160;&#61;&#160;5&#93; in group B versus 6&#37; &#91;n&#160;&#61;&#160;5&#93; in group A&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;002&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Multivariate analysis</span><p id="par0145" class="elsevierStylePara elsevierViewall">Values that reached statistical significance in the multivariate analysis were firstdegree AVB &#40;odds ratio &#91;OR&#93;&#160;&#61;&#160;7&#46;2&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;06&#41;&#44; AIAB &#40;OR&#160;&#61;&#160;12&#46;8&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;04&#41;&#44; moderate or severe LAE &#40;OR&#160;&#61;&#160;27&#46;1&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;02&#41;&#44; and the occurrence of &#62;1000 atrial extrasystoles &#40;OR&#160;&#61;&#160;15&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;01&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; This model offered a discrimination evaluated based on the area under the ROC curve of 0&#46;9 &#91;0&#46;78&#8722;0&#46;99&#93; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41; to differentiate which patients developed AF at two years of follow-up&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0150" class="elsevierStylePara elsevierViewall">At present&#44; there is much debate regarding the role of silent AF as the cause of CS due to the fact that this is a diagnosis of exclusion and&#44; above all&#44; due to the great heterogeneity of the literature available in relation to the patient profiles and the methods used to detect AF in the different studies performed&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">It is noteworthy that AF detection rates vary greatly between different papers&#44; even when the same ECG monitoring methods are used&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;12</span></a> Thus&#44; depending on how selected the population to be monitored is&#44; there will be a lower or greater likelihood of silent AF being identified as the cause of the CS&#46; It is precisely for this reason that the concept of ESUS was introduced&#44; i&#46;e&#46;&#44; to select a population in which AF is more likely to be responsible for the stroke&#46; Similarly&#44; the more exhaustive and extensive the screening for AF&#44; the greater the likelihood of detecting it&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">In our setting&#44; despite the results of the CRYSTAL-AF<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and EMBRACE studies&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> most patients with ESUS are not monitored with an implantable or textile wearable Holter since the cost of these devices is very high&#46; In fact&#44; there are cost-effectiveness studies comparing different monitoring strategies applied following an ischemic stroke&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> which conclude that both implantable devices and external monitoring for 30 days &#40;external loop recorders&#41; are not cost-effective&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">In this study&#44; the rate of AF detection by a 24&#160;h Holter-ECG was 11&#46;6&#37;&#44; a much higher figure than that reported in other large studies using the same monitoring method&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Patients included in the control arm of the CRYSTAL-AF study<span class="elsevierStyleSup">2</span> had a higher risk of developing AF than our cohort &#40;CHADS score of 2&#46;9 versus CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc score of 2&#41;&#44; and they were subjected to in-person follow-up with the option of having a HolterECG study &#40;at the Investigator&#8217;s discretion&#41; performed every month after the event and subsequently every 6 months&#46; Despite the above&#44; the rate of AF detection was 1&#46;4&#37; at 6 months&#44; 2&#46;0&#37; at 12 months&#44; and 3&#46;0&#37; at 36 months&#44; with the rates found in our study more than doubling these figures&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">These differences are most likely due to a better selection of the patients to be monitored &#40;ESUS in our study versus CS in the CRYSTAL-AF study&#41;&#44; as well as the closer follow-up carried out by us throughout the first year &#40;every 3 months&#41; and the systematic conduct of a Holter-ECG study during each consultation&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">In line with the findings of other authors&#44;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#44;26</span></a> in our study&#44; most episodes of AF were detected within the first 12 months&#46; Furthermore&#44; in our study&#44; the cost-effectiveness of monitoring beyond 18 months was null&#44; as no episodes of AF were detected between 18 and 24 months&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Following the conduct of the different studies in which AF was proposed as the potential cause of up to 30&#37; of ESUS&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> some studies were designed to attempt to determine whether anticoagulant therapy with direct-acting oral anticoagulants in patients with ESUS reduced stroke reoccurrence&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a> Their results demonstrated a clear lack of benefit of antiplatelet therapy and even a higher risk of hemorrhage associated with this treatment&#46; Thus&#44; it is essential to diagnose AF by ECG monitoring&#44; as only these patients will benefit from this therapy&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">However&#44; given that the percentage of patients with ESUS in whom AF is detected is limited&#44; the search for AF predictors is very useful to select patients who would benefit the most from prolonged monitoring&#44; considering its high cost and low availability&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Both first-degree AVB and A-IAB have been described in the general population as markers of LA fibrosis and atrial remodeling&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> and&#44; therefore&#44; of atrial electromechanical dysfunction&#44; which predisposes patients to developing AF&#46; In some studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a> the presence of A-IAB in the general population doubles the risk of experiencing AF during the follow-up&#46; In the study carried out by Mendieta et al&#46; on 75 patients with ESUS&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> A-IAB was the only independent predictor of AF during follow-up&#46; The presence of first-degree AVB has been directly related to an increased risk of developing AF in both the general population and patients with CS&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;28</span></a> These findings were confirmed in our study&#44; as our data showed that A-IAB behaves as an independent predictor of AF&#44; while first-degree AVB showed a tendency to do so without reaching statistical significance&#44; probably due to the small size of our study sample&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">In our cohort of 95 patients&#44; AEs within the moderate range &#40;&#62;1000 AEs&#47;24&#160;h&#41; behaved as a risk marker for developing AF in patients who experienced ESUS&#44; which reaffirms the results of other studies&#44; such as that performed by Gladstone et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> in which the percentage of AEs was the only independent predictor of AF in patients monitored for a prolonged period of time after a CS&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Despite LAE being one of the parameters most closely related to the subsequent onset of AF&#44;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> while moderate or severe LAE did behave as a predictor of AF&#44; mild LAE did not&#46; Thus&#44; although the relationship between the size of the LA and the onset of AF is very strong &#40;a 30&#37; increase in the LA is associated with a 43&#37; likelihood of developing AF in the general population&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> a high degree of enlargement is required&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">It is striking that mild LAE does not behave as a predictor of AF&#44; while the previously mentioned electrical parameters do&#46; Hence&#44; these parameters could be early markers of an atrial disease that could be present at an incipient development phase of atrial fibrosis&#44; prior to the occurrence of significant atrial enlargement&#46; Therefore&#44; according to our results&#44; these electrical parameters are more sensitive when predicting AF than LAE&#44; which needs to be moderate or severe to behave as a marker&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">In our study we identified three parameters that were independent predictors of the risk of developing AF &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; two of them electrical and one echocardiographic&#44; and all of them easily identifiable by means of simple and highly available tests&#44; such as an echocardiogram&#44; a 12-lead ECG&#44; or a 24-h Holter-ECG&#46; Therefore&#44; moderate or severe LAE&#44; A-IAB&#44; and a rate of &#62;1000 AES in a 24-h Holter-ECG could be used as predictors in subsequent prospective studies in which patients with a high risk of developing AF after an ESUS would be monitored by means of an implantable Holter-ECG and establishing a risk scale for AF occurrence&#46; In addition&#44; they could play a role as markers of incipient atrial fibrosis when designing studies in which patients with ESUS who would benefit the most from anticoagulation therapy would be appropriately selected&#44; as proposed in the ongoing ARCADIA study&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> in which the use of apixaban versus antiplatelet therapy in patients with CS is being compared&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">This is a retrospective study with a small number of patients and&#44; therefore&#44; with the limitations inherent to said fact&#46; However&#44; it is true that consecutive cases have been included and that an exhaustive and long-term follow-up was carried out&#46; The fact that patients were not monitored with an implantable Holter monitor may have underdetected some episodes of AF&#44; although the intensive Holter monitoring of all patients detected AF in a high percentage of them&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">To conclude&#44; moderate or severe LAE&#44; A-IAB&#44; and the presence of more than 1000 AEs in a 24-h Holter-ECG behaved as AF predictors in patients with ESUS&#46; First-degree AVB also showed a trend to do so&#44; albeit without reaching statistical significance&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of interest</span><p id="par0230" class="elsevierStylePara elsevierViewall">The authors of this paper declare no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objectives</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Atrial fibrillation &#40;AF&#41; detection in patients with embolic stroke of underdetermined source &#40;ESUS&#41;&#44; entails a change of medical treatment and a significant decrease in the incidence of new strokes&#46; It is necessary to determine which patients would benefit more from prolonged electrocardiographic monitoring&#46; Our aim was to find electrocardiographic and echocardiographic AF predictors in patients with ESUS&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">We performed a cohort study that included 95 consecutive patients admitted to the hospital because of an ESUS&#46; An electrocardiogram&#44; each subject in the study underwent a 24-h Holter-electrocardiogram &#40;Holter-ECG&#41; and an echocardiogram&#46; A 2-year follow up was also conducted&#44; with a 24-h Holter-ECG every three months for the first year&#44; and every 6 months during the second one&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">During the follow-up&#44; AF was detected in 11 patients &#40;11&#46;6&#37;&#41;&#44; with a detection rate of 3&#46;2&#37; at 6 months&#44; 7&#46;4&#37; at 12 months&#44; and 11&#46;6&#37; at 18 months as well as at 24 months&#46; The variables that were independently related to AF detection included moderate or severe left atrium dilation &#40;p&#160;&#61;&#160;&#46;02&#41;&#44; interatrial advanced block &#40;p&#160;&#61;&#160;&#46;04&#41; and more than 1000 premature atrial beats on 24&#160;h Holter-ECG &#40;p&#160;&#61;&#160;&#46;01&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Moderate or severe atrial dilation&#44; interatrial advanced block&#44; and the presence of more than 1000 premature atrial beats on 24&#160;h Holter-ECG behave as AF predictors in patients with ESUS&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivos</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">En el accidente cerebrovascular emb&#243;lico de origen indeterminado &#40;ESUS&#41;&#44; la detecci&#243;n de fibrilaci&#243;n auricular &#40;FA&#41; conlleva un cambio de tratamiento y una reducci&#243;n dr&#225;stica en la incidencia de nuevos ictus&#46; Es necesario determinar qu&#233; pacientes se benefician en mayor medida de una monitorizaci&#243;n electrocardiogr&#225;fica prolongada&#46; Nuestro objetivo fue la b&#250;squeda de predictores electrocardiogr&#225;ficos y ecocardiogr&#225;ficos de FA en pacientes con ESUS&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiales y m&#233;todos</span><p id="spar1085" class="elsevierStyleSimplePara elsevierViewall">Se dise&#241;&#243; un estudio observacional de cohortes en el que se incluyeron 95 pacientes consecutivos que ingresaron por ESUS en un hospital terciario&#46; A todos se les realiz&#243; un electrocardiograma &#40;ECG&#41;&#44; un Holter electrocardiograma &#40;Holter-ECG&#41; de 24&#160;horas y un ecocardiograma durante el ingreso&#46; Se realiz&#243; un seguimiento presencial durante dos a&#241;os mediante Holter-ECG de 24&#160;horas&#44; trimestral durante el primer a&#241;o y semestral durante el segundo&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Durante el seguimiento&#44; se detect&#243; FA en 11 pacientes &#40;11&#44;6&#37;&#41;&#44; siendo la tasa detecci&#243;n del 3&#44;2&#37; a los 6 meses&#44; 7&#44;4&#37; a los 12 meses&#44; y 11&#44;6&#37; a los 18 y a los 24 meses&#46; Las variables que se relacionaron de forma independiente con el desarrollo de FA fueron la dilataci&#243;n en grado moderado o severo de la aur&#237;cula izquierda &#40;AI&#41; &#40;p&#160;&#61;&#160;002&#41;&#44; el bloqueo interauricular avanzado &#40;BIA-A&#41; &#40;p&#160;&#61;&#160;0&#44;04&#41;&#44; y la presencia de m&#225;s de 1000 extras&#237;stoles auriculares &#40;EA&#41; en Holter-ECG de 24&#160;horas &#40;p&#160;&#61;&#160;0&#44;01&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">La dilataci&#243;n en un grado moderado o severo de AI&#44; el BIA-A&#44; y la presencia de m&#225;s de 1000 EA en Holter-ECG de 24&#160;horas se comportan como predictores independientes de FA en pacientes con ESUS&#46;</p></span>"
        "secciones" => array:4 [
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            "titulo" => "Antecedentes y objetivos"
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          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Materiales y m&#233;todos"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
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          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Ramos-Maqueda J&#44; Navarro-Valverde C&#44; Esteve-Ruiz I&#44; Cabrera-Ramos M&#44; Rivera-L&#243;pez R&#44; Garc&#237;a-Medina D&#44; et al&#46; Predictores de fibrilaci&#243;n auricular en pacientes con ictus emb&#243;lico de origen indeterminado&#46; Med Clin &#40;Barc&#41;&#46; 2021&#59;157&#58;555&#8211;560&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Bar graph representation of atrial fibrillation predictors&#58; presence of more than 1000 atrial extrasystoles in a 24-h Holter-ECG&#44; moderate or severe left atrial enlargement&#44; and advanced interatrial block in an ECG in patients who experienced atrial fibrillation during the follow-up versus those who did not&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Area under the receiver operating characteristic &#40;ROC&#41; curve of the logistic regression model with respect to occurrence of AF at 2 years of follow-up&#46;</p>"
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      2 => array:8 [
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          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">AF&#58; atrial fibrillation&#59; DLP&#58; dyslipidemia&#59; DM&#58; diabetes mellitus&#59; GFR&#58; glomerular filtration rate&#59; HBP&#58; high blood pressure&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Results are expressed as n &#40;&#37;&#41;&#44; a mean &#40;standard deviation&#41;&#44; and a median &#91;p25-p75&#93;&#46;</p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients&#8217; baseline characteristics&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total patients &#40;n&#160;&#61;&#160;95&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Age&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">67&#46;7 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">67&#46;2 &#40;11&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">73&#46;3 &#40;7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Male&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">68 &#40;71&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">61 &#40;72&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">7 &#40;63&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">HBP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">66 &#40;69&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">57 &#40;67&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9 &#40;81&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">DM&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">30 &#40;31&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">27 &#40;32&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;27&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">DLP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">35 &#40;36&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">32 &#40;28&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;27&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Smoker&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">26 &#40;27&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">25 &#40;29&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;9&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GFR &#60;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14 &#40;14&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12 &#40;14&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">GFR &#60;90&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">AF&#58; atrial fibrillation&#59; A-IAB&#58; advanced interatrial block&#59; AVB&#58; atrioventricular block&#59; Holter-ECG&#58; Holter electrocardiogram&#59; LAE&#58; left atrial enlargement&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Results are expressed as n &#40;&#37;&#41;&#44; a mean &#40;standard deviation&#41;&#44; and a median &#91;p25&#8211;p75&#93;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients in whom AF was not detected &#40;n&#160;&#61;&#160;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients in whom AF was detected &#40;n&#160;&#61;&#160;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clinical parameters&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#91;1&#8211;4&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#91;2&#8211;4&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#91;3&#46;0&#93; Electrocardiographic parameters</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P wave &#40;ms&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100 &#91;80&#8722;120&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">120 &#91;80&#8722;160&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">First-degree AVB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;13&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;36&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Corrected QT interval&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">403 &#40;16&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">405&#46;9 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A-IAB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;27&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#91;2&#46;0&#93; 24-h Holter-ECG parameters</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Atrial tachycardia &#62;20 beats&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;9&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Atrial extrasystoles&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#46;5 &#91;22&#8722;558&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">234 &#91;75&#8722;1490&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;1000 atrial extrasystoles&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;9&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;45&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#91;2&#46;0&#93; Echocardiographic parameters</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anteroposterior LA diameter &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#46;7 &#40;5&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#46;2 &#40;8&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LAE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;26&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;45&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Moderate LAE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;45&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2782133.png"
              ]
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">AF predictors in patients according to whether or not AF was detected during the follow-up&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0025"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A-IAB&#58; advanced interatrial block&#59; AVB&#58; atrioventricular block&#59; LAE&#58; left atrial enlargement&#59; OR&#58; odds ratio&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Predictors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Univariate analysis OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Multivariate analysis OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">First-degree AVB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">7&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">27&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#62;1000 atrial extrasystoles&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;006&nbsp;\t\t\t\t\t\t\n
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