ACE2L Score for Prediction of Atrial Fibrillation in Patients with Cryptogenic Stroke

Background Atrial Fibrillation (AF) is associated with a high risk of ischemic stroke. Paroxysmal AF (pAF) is difficult to diagnose and can lead to the underutilization of anticoagulants in stroke prevention. AF detection remains crucial to initiate anticoagulation therapy in patients with cryptogenic stroke as the standard of care in the real-world practice. We present a novel scoring tool termed ACE2L that relies on A ge > 60, C ortical or embolic stroke, E CG p-wave terminal force > 5000 µVms, E chocardiographic evidence of left atrial dilatation, and lack of extracranial L arge vessel hemodynamic stenosis on imaging that may be used to guide management in patients with cryptogenic stroke. Objectives Develop a score to predict underlying AF risk in patients with cryptogenic stroke. Methods We retrospectively identified patients who had an acute ischemic stroke and classified them as AF or non-AF by two years after the initial stroke. Patients with pre-existing diagnosis of AF were excluded. Results Data was collected on 100 patients, of which 49 were included in the pAF group and 51 in the non-pAF group. The ACE2L score was shown to have high sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in predicting underlying AF by two years after initial ischemic stroke. Conclusion The ACE2L scoring tool has been shown to have high sensitivity, specificity, PPV, and NPV in predicting AF in patients with cryptogenic stroke. Future prospective studies are needed to clearly establish the utility and role of this novel scoring tool in the management of cryptogenic stroke.