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Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Association between electrocardiographic and echocardiographic atrial abnormalities and prognosis in cryptogenic
Eduardo Gatti Pianca1, Luiz Gustavo Bravosi da Rosa2, Pedro Tregnago Barcellos3
1Cardiology Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, RS, Brazil; Post-Graduate Program in Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Insights
Left atrial enlargement, identified by ECG and echocardiogram, is linked to more disabling cryptogenic strokes. This finding aids in identifying patients with poorer prognoses and potential atrial cardiopathy involvement.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Atrial fibrillation is a known cause of cryptogenic stroke (CS).
- The association between left atrial (LA) abnormalities and stroke severity in sinus rhythm patients is less understood.
- Identifying predictors of stroke disability is crucial for patient management.
Purpose of the Study:
- To investigate the relationship between electrocardiographic (ECG) P-wave abnormalities and echocardiographic LA measures with neurological disability in CS patients.
- To determine if LA abnormalities can identify patients with more severe strokes.
Main Methods:
- Retrospective cohort study of 143 hospitalized CS patients.
- Patients classified by modified Rankin Scale (mRS) at discharge and 3 months.
- LA abnormalities assessed via ECG (P-wave, axis, enlargement) and echocardiography (LA diameter, volume index).
Main Results:
- Disabling strokes (mRS ≥ 2) were associated with enlarged LA volume index on echocardiogram (48% vs. 25%, p=0.01) at discharge.
- This association remained significant after adjusting for clinical factors.
- Enlarged LA volume index was also more prevalent at 3 months (52% vs. 25%, p=0.03).
- ECG-identified LA enlargement (downward deflection) was more common in disabling strokes.
Conclusions:
- Left atrial enlargement, detected by ECG and echocardiography, correlates with more disabling cryptogenic strokes.
- These findings can help identify patients with a poorer prognosis.
- This highlights the potential role of atrial cardiopathy in the cardioembolic stroke pathway.
Background And Purpose:
The role of atrial fibrillation in cryptogenic stroke (CS) is well known. However, the usefulness of left atrial (LA) electrical and morphological abnormalities to identify more disabling strokes in sinus rhythm patients is less studied. We evaluated the association between electrocardiographic P-wave abnormalities and echocardiographic LA measures with neurological disability in patients with cryptogenic stroke.
Methods:
In a retrospective cohort, we included all consecutive hospitalized patients with cryptogenic stroke. Patients were classified according to modified Rankin scale at hospital discharge and at 3 months. LA abnormalities were identified by electrocardiographic (ECG) P-wave, axis and LA enlargement criteria, and by bidimensional echocardiograph through left atrial diameter and volume index.
Results:
Among the 143 patients with CS (63.4 ± 14.2 years, 53% women), 70 patients were classified as non-disabling stroke (Rankin score < 2) and 73 patients as disabling stroke (Rankin score ≥ 2) at hospital discharge. On echocardiogram, more patients with disabling stroke presented with enlarged LA volume index (48% vs. 25%; p = 0.01). This difference remained significant after adjustment for age, gender, CHA2DS2-VASc and NIHSS scores (p = 0.02) and even when the LA volume index was analyzed as a continuous variable (p = 0.055). Also, enlarged LA volume index was more prevalent (52% vs. 25%; p = 0.03) among those with disabling stroke at 3 months after hospital discharge. Among ECG criteria, only the LA enlargement assessed by downward deflection was more prevalent in disabling stroke.
Conclusion:
Our study demonstrated an association between left atrial enlargement, assessed by downward deflection from ECG and volume index from echocardiogram, and more disabling cryptogenic strokes. This information could help to identify patients with poorer prognosis, or a subgroup where atrial cardiopathy may play a role in cardioembolic pathway.
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