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Updated: Jul 2, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Cardiac imaging correlates and predictors of stroke in patients with atrial fibrillation: a meta-analysis
Jean Jacques Noubiap1,2, Ulrich Flore Nyaga3, Melissa E Middeldorp2,4
1Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA.
Insights
Cardiac imaging reveals new stroke predictors for atrial fibrillation patients. Parameters like left atrial enlargement and appendage morphology significantly increase stroke risk, improving current risk assessments.
Area of Science:
- Cardiology
- Medical Imaging
- Thrombosis Research
Background:
- Current stroke risk stratification for atrial fibrillation (AF) patients requires novel nonclinical parameters.
- Cardiac imaging may offer valuable insights into predicting stroke or systemic embolism in AF.
Approach:
- A comprehensive meta-analysis was conducted, pooling data from 64 studies.
- Searched MEDLINE, EMBASE, and Web of Science for relevant studies up to November 2022.
- Employed random effects meta-analysis to synthesize findings.
Key Points:
- Left atrial spontaneous echo-contrast, non-chicken wing left atrial appendage (LAA) morphology, left atrial enlargement, and larger LAA orifice diameter strongly correlate with stroke.
- Other identified predictors include increased left atrial sphericity, volume, and volume index; reduced left atrial reservoir strain; elevated left ventricular mass index; and higher E/e' ratio.
- Left atrial appendage volume did not show a significant association with stroke risk.
Conclusions:
- Identified cardiac imaging parameters show promise in enhancing stroke risk prediction accuracy for AF patients.
- Future research should focus on integrated risk scores combining clinical factors, biomarkers, and imaging data.
- These findings can refine clinical decision-making for AF-related thromboembolism prevention.
Background:
New nonclinical parameters are needed to improve the current stroke risk stratification schemes for patients with atrial fibrillation. This study aimed to summarize data on potential cardiac imaging correlates and predictors of stroke or systemic embolism in patients with atrial fibrillation.
Methods:
MEDLINE, EMBASE, and Web of Science were searched to identify all published studies providing relevant data through 16 November 2022. Random effects meta-analysis method was used to pool estimates.
Results:
We included 64 studies reporting data from a pooled population of 56 639 patients. Left atrial spontaneous echo-contrast [adjusted odds ratio (aOR) 3.32, 95% confidence interval (CI) 1.98-5.49], nonchicken wing left atrial appendage (LAA) morphology (aOR 2.15, 95% CI 1.11-4.18), left atrial enlargement (aOR 2.12, 95% CI 1.45-3.08), and higher LAA orifice diameter (aOR 1.56, 95% CI 1.18-2.05) were highly associated with stroke. Other parameters associated with stroke included higher left atrial sphericity (aOR 1.14, 95% CI 1.01-1.29), higher left atrial volume (aOR 1.03, 95% CI 1.01-1.04), higher left atrial volume index (aOR 1.014, 95% CI 1.004-1.023), lower left atrial reservoir strain [adjusted hazard ratio (aHR) 0.86, 95% CI 0.76-0.98], higher left ventricular mass index (aOR 1.010, 95% CI 1.005-1.015) and E / e' ratio (aOR 1.12, 95% CI 1.07-1.16). There was no association between LAA volume (aOR 1.37, 95% CI 0.85-2.21) and stroke.
Conclusion:
These cardiac imaging parameters identified as potential predictors of thromboembolism may improve the accuracy of stroke risk stratification schemes in patients with atrial fibrillation. Further studies should evaluate the performance of holistic risk scores including clinical factors, biomarkers, and cardiac imaging.
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