TY - JOUR

T1 - Utility of left atrial strain for predicting atrial fibrillation following ischemic stroke

AU - Rasmussen, Sif Maja Aas

AU - Olsen, Flemming Javier

AU - Jorgensen, Peter Godsk

AU - Fritz-Hansen, Thomas

AU - Jespersen, Thomas

AU - Gislason, Gunnar

AU - Biering-Sorensen, Tor

PY - 2019

Y1 - 2019

N2 - Twenty-five percent of ischemic strokes (IS) are cryptogenic, but it is estimated that paroxysmal atrial fibrillation (PAF) is the underlying cause in up to a third of cases. We aimed to investigate the predictive value of speckle tracking of the left atrium (LA) in diagnosing PAF in IS patients. We retrospectively studied 186 IS patients with a clinical echocardiographic examination during sinus rhythm. Outcome was PAF defined by at least one reported episode of AF following their IS. Conventional echocardiographic measures were performed. Global longitudinal strain (GLS), LA reservoir-(epsilon(s)), conduit-(epsilon(e)), contraction-strain (epsilon(a)) and LA dyssynchrony (standard deviation of time-to-peak epsilon(s); LA SD-T2P) were obtained by left ventricular and LA speckle tracking. Of 186 patients, 28 (15%) were diagnosed with PAF. PAF-patients did not differ from non-PAF patients with regards to GLS nor SD-TPS, but atrial strain measures were significantly impaired at baseline (epsilon(s) 27 vs. 35%, epsilon(e) 12 vs. 16%, epsilon(a) 15 vs. 18%, p < 0.02 for all, for PAF and non-PAF, respectively). However, only epsilon(s) remained independently associated with PAF after adjustment for clinical and echocardiographic parameters (OR 1.13 [1.04; 1.22], p = 0.003, per 1% decrease). epsilon(s) also provided the highest area under the receiver operating characteristic curve among all variables (AUC = 0.74). With a cutoff of 29%, epsilon(s) had a specificity of 76% and a negative predictive value of 93%. Atrial reservoir strain is independently associated with PAF and may be used to improve the diagnosis of PAF following IS.

AB - Twenty-five percent of ischemic strokes (IS) are cryptogenic, but it is estimated that paroxysmal atrial fibrillation (PAF) is the underlying cause in up to a third of cases. We aimed to investigate the predictive value of speckle tracking of the left atrium (LA) in diagnosing PAF in IS patients. We retrospectively studied 186 IS patients with a clinical echocardiographic examination during sinus rhythm. Outcome was PAF defined by at least one reported episode of AF following their IS. Conventional echocardiographic measures were performed. Global longitudinal strain (GLS), LA reservoir-(epsilon(s)), conduit-(epsilon(e)), contraction-strain (epsilon(a)) and LA dyssynchrony (standard deviation of time-to-peak epsilon(s); LA SD-T2P) were obtained by left ventricular and LA speckle tracking. Of 186 patients, 28 (15%) were diagnosed with PAF. PAF-patients did not differ from non-PAF patients with regards to GLS nor SD-TPS, but atrial strain measures were significantly impaired at baseline (epsilon(s) 27 vs. 35%, epsilon(e) 12 vs. 16%, epsilon(a) 15 vs. 18%, p < 0.02 for all, for PAF and non-PAF, respectively). However, only epsilon(s) remained independently associated with PAF after adjustment for clinical and echocardiographic parameters (OR 1.13 [1.04; 1.22], p = 0.003, per 1% decrease). epsilon(s) also provided the highest area under the receiver operating characteristic curve among all variables (AUC = 0.74). With a cutoff of 29%, epsilon(s) had a specificity of 76% and a negative predictive value of 93%. Atrial reservoir strain is independently associated with PAF and may be used to improve the diagnosis of PAF following IS.

KW - Speckle tracking echocardiography

KW - Strain

KW - Atrial fibrillation

KW - Stroke

U2 - 10.1007/s10554-019-01601-0

DO - 10.1007/s10554-019-01601-0

M3 - Journal article

C2 - 31028567

VL - 35

SP - 1605

EP - 1613

JO - International Journal of Cardiovascular Imaging

JF - International Journal of Cardiovascular Imaging

SN - 1569-5794

IS - 9

ER -