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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
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Atrial strain and occult atrial fibrillation in cryptogenic stroke patients: a systematic review and meta-analysis

Ioannis Anagnostopoulos1, Maria Kousta2, Charalampos Kossyvakis2

  • 1Cardiology Department, Athens General Hospital "G. Gennimatas", 154 Mesogion Avenue, 11527, Athens, Greece. iannis.anagnostopoulos@gmail.com.

Clinical Research in Cardiology : Official Journal of the German Cardiac Society
|May 8, 2023
PubMed

Insights

Left atrial strain, including peak longitudinal (PALS) and peak contractile (PACS) measures, is reduced in cryptogenic stroke patients with newly diagnosed atrial fibrillation (AF). Lower strain values may help identify patients needing further AF monitoring.

Area of Science:

  • Cardiology
  • Neurology
  • Medical Imaging

Background:

  • Cryptogenic stroke (CS) is a significant cause of morbidity, with atrial fibrillation (AF) being a common underlying pathology.
  • Identifying silent AF in CS patients is crucial for preventing recurrent strokes and improving patient outcomes.
  • Current diagnostic methods may not adequately detect all cases of occult AF.

Approach:

  • A systematic review and meta-analysis were conducted to assess the relationship between left atrial strain parameters and the incidence of newly diagnosed AF in CS patients.
  • Eleven studies, encompassing 2081 patients, were analyzed.
  • Speckle tracking echocardiography was used to quantify peak left atrial longitudinal strain (PALS) and peak contractile strain (PACS).

Key Points:

  • The incidence of occult AF in the analyzed CS patient cohort was 19%.
  • Both PALS and PACS were significantly lower in patients subsequently diagnosed with AF.
  • Diagnostic accuracy analysis suggested cut-off values for PALS (<20%) and PACS (<11%) that could aid in identifying patients with a higher likelihood of occult AF.

Conclusions:

  • Reduced left atrial strain (PALS and PACS) is associated with the presence of silent AF in patients with cryptogenic stroke.
  • Specific strain cut-off values may assist clinicians in selecting patients who would benefit most from extended cardiac rhythm monitoring.
  • Further research is warranted to validate these findings and refine diagnostic strategies for occult AF in CS.
Abstract

Keywords:
Atrial fibrillationDiagnosisEchocardiographyStrainStroke

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