AF patients with an estimated glomerular ltration rate < 60 mL/min compared with those with an estimated glomerular ltration rate $ 60 mL/min have increased risk of stroke/ P < .001), with a 0.41% (0.17%-0.65%) annual increase in rate for a 10 mL/min decrease in renal function.49 The risk is higher in individuals requiring renal replacement therapy (HR, 1.83; 95% CI, 1.57-2.14; P < .001). There is also an increased risk of bleeding in individuals with AF and CKD, compared with those without CKD.50 Conversely, AF is associated with an increased risk of The clinical relevance of renal function is not only for risk prediction but also for choice of anticoagulation and other (see AF and CKD section). Over the last decade, rigorous detection strategies have shown that the prevalence of AF in cryptogenic stroke is likely to be as high as 30%.55 A systematic review and meta-analysis after TIA has shown a pooled AF detection rate for all methods of 4% (95% CI, 2-7).56 Echocardiographic Risk Factors: The role of echocardiography in evaluation before cardioversion or ablation, and in predicting the presence of left atrial appendage (LAA) thrombus is dealt with in sections Cardioversion and Catheter or Surgical Ablation, Electrophysiological Procedures. There may also be a role in evaluating thromboembolic risk strati cation to select appropriate antithrombotic therapy. e-Table 4 summarizes major studies which have shown an association between transthoracic echocardiography (TTE) parameters and ischemic stroke. However, there are very limited data to suggest that there would be any incremental clinical bene t in risk prediction, and moreover there is no evidence that management (in terms of oral anticoagulant [OAC]) would be changed.57 Nevertheless, the most consistent independent predictor of ischemic stroke on TTE is the presence of moderate- severe left ventricular systolic dysfunction. 