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Published on: July 20, 2022
Left Atrium Assessment by Speckle Tracking Echocardiography in Cryptogenic Stroke: Seeking Silent Atrial Fibrillation
Mireia Ble1,2, Begoña Benito3,4, Elisa Cuadrado-Godia3,5
1Medicine Department, Universidad Autónoma de Barcelona, 08035 Barcelona, Spain.
Insights
Silent atrial fibrillation (AF) is a key cause of cryptogenic stroke (CrS). Speckle tracking echocardiography effectively detects underlying atrial disease in CrS patients, improving diagnosis.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Silent atrial fibrillation (AF) is a suspected cause of cryptogenic stroke (CrS).
- Early detection of AF is crucial for stroke prevention and management.
- Assessing atrial structure and function may aid in identifying patients at risk.
Purpose of the Study:
- To analyze atrial size and function using speckle tracking echocardiography (STE) in cryptogenic stroke patients.
- To identify echocardiographic markers predictive of silent atrial fibrillation in this population.
- To evaluate the utility of STE in diagnosing subclinical atrial disease.
Main Methods:
- Prospective inclusion of 75 cryptogenic stroke patients.
- Echocardiogram analysis including left atrial ejection fraction (LAEF) and atrial strain (PALs, PACs) via STE.
- Implantation of insertable cardiac monitors to detect AF episodes (≥1 min) within one year post-stroke.
Main Results:
- Atrial fibrillation was diagnosed in 49% of patients.
- Patients with AF exhibited significantly higher atrial volume and impaired atrial function (lower PALs, PACs, and LAEF; p < 0.001).
- Atrial dysfunction was present in 18 patients with non-enlarged atria, and AF was diagnosed in 20 of them.
Conclusions:
- Speckle tracking echocardiography enhances the diagnosis of silent atrial disease in cryptogenic stroke patients.
- Atrial volume, LAEF, and strain parameters are independently associated with AF detection.
- Established cut-off values (LAEF < 55%, PALs < 21.4%, PACs < 12.9%) aid in identifying patients with atrial dysfunction and AF risk.
Abstract:
Silent atrial fibrillation (AF) may be the cause of some cryptogenic strokes (CrS). The aim of the study was to analyse atrial size and function by speckle tracking echocardiography in CrS patients to detect atrial disease. Patients admitted to the hospital due to CrS were included prospectively. Echocardiogram analysis included left atrial ejection fraction (LAEF) and atrial strain. Insertable cardiac monitor was implanted, and AF was defined as an episode of ≥1 min in the first year after stroke. Left atrial enlargement was defined as indexed volume > 34 mL/m2. Seventy-five consecutive patients were included, aged 76 ± 9 years (arterial hypertension 75%). AF was diagnosed in 49% of cases. The AF group had higher atrial volume and worse atrial function: peak atrial longitudinal strain (PALs) 19.6 ± 5.7% vs. 29.5 ± 7.2%, peak atrial contraction strain (PACs) 8.9 ± 3.9% vs. 16.5 ± 6%, LAEF 46.8 ± 11.5% vs. 60.6 ± 5.2%; p < 0.001. AF was diagnosed in 20 of 53 patients with non-enlarged atrium, and in 18 of them, atrial dysfunction was present. The multivariate logistic regression analysis demonstrated an independent association between detection of AF and atrial volume, LAEF, and strain. Cut-off values were obtained: LAEF < 55%, PALs < 21.4%, and PACs < 12.9%. In conclusion, speckle tracking echocardiography in CrS patients improves silent atrial disease diagnosis, with or without atrial enlargement.
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