Abstract 207: Infarct Topography and Detection of Atrial Fibrillation in Cryptogenic Stroke: The CRYSTAL-AF Study
Bibliographic record
Abstract
Introduction: The Cryptogenic Stroke and Underlying Atrial Fibrillation (CRYSTAL AF) trial showed that continuous cardiac monitoring with an insertable cardiac monitor (ICM) detected atrial fibrillation (AF) in patients (pts) with cryptogenic ischemic stroke (CS) at a rate approximately 7 times greater than standard monitoring, with AF detection rates of 12.4% at one yearand 30.0% at three years in the ICM arm. We hypothesized that among the CS pts who underwent continuous monitoring there would be a radiographic pattern of infarction (acute and/or chronic) associated with an increased likelihood of subsequent AF detection by 12 months. Methods: In this trial, 221 pts with recent CS confirmed by brain imaging were randomized to long-term continuous cardiac monitoring. The brain images, including 86 CT scans and 166 MRI scans, from 212 pts were available for review by a core lab to determine the distribution of acute and chronic lesions. Hazard ratios (HR) comparing pts with and without AF detected at 12 months were calculated for the imaging characteristics reviewed, and the log-rank test was used to determine significance. Results: Index infarctions (pts could have >1 infarction as their index event) were cortical (41.6%); subcortical (18.1%); both cortical and subcortical (21.7%); lacunar (24.4%); posterior circulation (8.1%); and internal border zone (0.9%). Old ischemic infarctions were found in 106 pts (48.0%), including leukoaraiosis in 31.7%. No acute lesion pattern was significantly associated with AF detection at 12 months. However, detection of AF was more frequent in pts having chronic infarcts (HR 2.84 [95% CI 1.13-7.15], p=0.02), with territorial old infarctions (HR 2.37 [95% CI 0.98-5.72], p=0.05) or leukoaraiosis (HR 2.94 [95% CI 1.28-6.71], p <0.01) contributing most to increased AF detection. Conclusions: In pts with CS who underwent continuous cardiac monitoring, no acute infarction pattern predicted detection of AF at 12 months. The presence of old infarcts was associated with detection of AF but the effect size was small. This suggests that long-term monitoring should be considered in all pts with CS as defined in CRYSTAL AF.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".