Left atrial function to identify patients with atrial fibrillation at high risk of stroke: new insights from a large...

Area of Science:

• Cardiology
• Medical Imaging
• Stroke Prevention

Background:

• Atrial fibrillation (AF) significantly increases ischaemic stroke risk.
• The CHA2DS2-VASc score is a standard risk assessment tool for AF patients.
• Echocardiography may offer refined risk stratification, especially for low-risk AF individuals.

Purpose of the Study:

• To investigate the association between advanced echocardiographic parameters and ischaemic stroke risk.
• To determine if echocardiographic findings provide stroke risk stratification independent of the CHA2DS2-VASc score.
• To evaluate the utility of these parameters in guiding anticoagulation decisions in newly diagnosed AF patients.

Main Methods:

• A cohort of 1,361 patients with newly diagnosed AF underwent baseline transthoracic echocardiography.
• Evaluated echocardiographic parameters included left atrial (LA) volumes, LA reservoir strain, and P-wave to A' duration on tissue Doppler imaging (PA-TDI).
• Cox proportional hazard models were used to assess the independent association of echocardiographic parameters with stroke occurrence over a mean follow-up of 7.9 years.

Main Results:

• 100 patients (7%) experienced an ischaemic stroke, with a higher incidence in the first year post-AF diagnosis.
• Patients who suffered a stroke had reduced LA reservoir and conduit strains and prolonged PA-TDI compared to those without stroke.
• Left atrial reservoir strain and PA-TDI were independently associated with stroke risk, even after accounting for CHA2DS2-VASc score, age, and anticoagulation.

Conclusions:

• Advanced echocardiographic assessments, specifically LA reservoir strain and PA-TDI, offer valuable stroke risk stratification beyond the CHA2DS2-VASc score.
• These echocardiographic parameters may aid in optimizing anticoagulation therapy decisions for patients newly diagnosed with AF.
• Echocardiography provides a refined approach to identifying stroke risk in AF patients.