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Advanced Echocardiography With Left Atrial Strain and Indexed Left Atrial Three-Dimensional Volume for Predicting
Alberto Vera1, Alberto Cecconi1, Álvaro Ximénez-Carrillo2
1Cardiology Department, La Princesa University Hospital, Autonomous University of Madrid. IIS-IP, Madrid, Spain.
Insights
Advanced echocardiography, including left atrial strain (LAS) and 3D left atrial volume, can predict atrial fibrillation (AF) in cryptogenic stroke (CS) patients. Lower LAS contraction and higher 3D left atrial volume independently identified AF, aiding secondary prevention strategies.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Cryptogenic stroke (CS) accounts for one-third of ischemic strokes, with atrial fibrillation (AF) detected in up to 30% of cases.
- Predicting AF is crucial for guiding optimal secondary prevention strategies in CS patients.
- Current evidence on advanced echocardiography's role in predicting AF in CS is limited.
Purpose of the Study:
- To evaluate the predictive value of advanced echocardiographic parameters, specifically left atrial 3-dimensional (3D) indexed volume and left atrial strain (LAS), for detecting underlying AF in patients with CS.
- To identify independent predictors of AF using these advanced echocardiographic techniques.
Main Methods:
- Prospective recruitment of 78 patients with ischemic stroke or TIA (ABCD2 scale ≥4) of unknown etiology from April 2019 to November 2021.
- Echocardiography performed during admission, including measurements of LA diastolic indexed volume, 3D LA indexed volume, and LAS (reservoir, conduct, contraction).
- 15-day wearable Holter monitoring for AF detection, with AF development as the primary outcome.
Main Results:
- Twenty-two patients (28%) developed AF during follow-up.
- Patients with AF were older and had significantly higher LA diastolic and 3D indexed volumes.
- Significantly lower LAS reservoir, LAS conduct, and LAS contraction (LASct) were observed in patients with AF (all p <0.001).
- Multivariate analysis identified LASct <13.5% and LA 3D indexed volume >44.5 ml/m² as independent predictors of AF (OR 10.9, p=0.042).
Conclusions:
- Left atrial strain contraction (LASct) <13.5% and 3D left atrial indexed volume >44.5 ml/m² are independent predictors of underlying AF in CS patients.
- Advanced echocardiography techniques, particularly LAS and 3D LA volume, demonstrate utility in identifying AF in this challenging clinical population.
- These findings support the use of advanced echocardiography for risk stratification and guiding secondary prevention in cryptogenic stroke.
Abstract:
Cryptogenic stroke (CS) represents 1/3 of ischemic strokes. Atrial fibrillation (AF) can be detected in up to 30% of CS. Therefore, there is a clinical need for predicting AF to guide the optimal secondary prevention strategy. The evidence about the role of advanced echocardiography, including left atrial 3-dimensional (3D) index volume and left atrial strain (LAS) techniques, to predict underlying AF in this setting is lacking. From April 2019 to November 2021, 78 consecutive patients with ischemic stroke or transient ischemic attack with ABCD2 scale ≥4 of unknown etiology were prospectively recruited. Echocardiography was performed during admission. All patients underwent 15 days of wearable Holter monitoring. The primary outcome measure was AF detection during follow-up. Twenty-two patients (28%) developed AF. Patients in the AF group were older (81 ± 6.3 vs 76.5 ± 7.8 years; p = 0.012). Left atrial (LA) diastolic indexed volume was higher in the AF group (37.2 ± 12.8 vs 29.7 ± 11 ml/m2 p = 0.01). Three-D LA indexed volume was also higher in patients with AF (41.4 ± 14 vs 32.2 ± 10 ml/m2 p = 0.009). LAS reservoir, LAS conduct, and LAS contraction (LASct) were significantly lower in patients with AF (19 ± 5.6 vs 32% ± 10.3%; 9 ± 4.5 vs 15 ± 7.6; 10 ± 5.3 vs 17 ± 6.4, respectively, all p <0.001). On multivariate analysis, LASct <13.5% and LA 3D indexed volume >44.5 ml/m2 were independent predictors of AF (odds ratio 10.9 [95% confidence interval 1.09 to 108.2], p = 0.042). In conclusion, LASct <13.5% and LA 3D indexed volume >44.5 ml/m2 are independent predictors of underlying AF in patients with CS. Our results show the usefulness of advanced echocardiography in this challenging clinical setting.
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