Computer-Assisted Electrocardiogram Analysis Improves Risk Assessment of Underlying Atrial Fibrillation in Cryptogenic Stroke
Bibliographic record
Abstract
Background: The detection of underlying paroxysmal atrial fibrillation (AF) in patients with cryptogenic stroke (CS) can be challenging, and there is great interest in finding predictors of its hidden presence. The recent development of sophisticated software has enhanced the diagnostic and prognostic performance of the 12-lead electrocardiogram (ECG). Our aim was to assess the additional role of a computer-assisted ECG analysis in identifying predictors of AF in patients with CS. Methods: Sixty-seven patients with ischemic stroke or high-risk transient ischemic attack of unknown etiology were prospectively studied. Their 12-lead digitized ECG was analyzed with dedicated software, quantifying 468 morphological variables. The main clinical, biochemical, and echocardiographic variables were also collected. At discharge, patients were monitored with a wearable Holter for 15 days, and the primary outcome was the detection of AF. Results: The median age was 80 (interquartile range (IQR): 73 - 84) and AF was detected in 21 patients (31.3%). After preselecting significant ECG variables from the univariate analysis, a multivariate regression including other significant clinical, biochemical and echocardiographic predictors of AF was performed. Among the automatically analyzed ECG parameters, the amplitude of the R wave in V1 (V1_ramp) was significantly associated with the outcome. The best model to predict AF was composed of age, N-terminal B-type natriuretic peptide (NT-proBNP), left atrial reservoir strain (LASr) and V1_ramp. This model showed good discrimination capacity (corrected Somer’s Dxy: 0.907, Brier’s B: 0.079, area under the curve (AUC): 0.941) and performed better than the same model without the ECG variable (Somer’s Dxy: 0.827, Brier’s B: 0.119, AUC: 0.896). Conclusions: The addition of computer-assisted ECG analysis can help stratify the risk of AF in the challenging clinical setting of CS.
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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".