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Atrial Imaging and Cardiac Rhythm in Cryptogenic Embolic Stroke: The ARIES Study
Ricardo Rigual1, Sergio Castrejón-Castrejón2, Lucía Fernández-Gassó3
1Department of Neurology and Stroke Center La Paz University Hospital. La Paz University Hospital Research Institute (IdiPAZ). Universidad Autónoma de Madrid Madrid Spain.
Insights
Cryptogenic stroke patients frequently have atrial fibrillation (AF) or high burden of ectopic atrial activity (HBEA). AF is linked to impaired left atrial function, suggesting advanced echocardiography aids monitoring selection.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Cryptogenic stroke often stems from unknown cardioembolic sources.
- Atrial fibrillation (AF) and high burden of ectopic atrial activity (HBEA) are potential contributors.
- Assessing atrial function and outcomes in these patients is crucial.
Purpose of the Study:
- To analyze the incidence of AF and HBEA in cryptogenic stroke patients.
- To compare left atrial (LA) function using advanced echocardiography across different atrial rhythms.
- To evaluate 1-year stroke recurrence and mortality rates.
Main Methods:
- The observational ARIES study included 109 cryptogenic stroke patients.
- Two 30-day Holter-ECGs assessed AF and HBEA frequency.
- Advanced echocardiography evaluated LA structure and function (volumes, ejection fraction, strain).
Main Results:
- 32.1% had AF, 24.8% had HBEA, and 43.1% had normal sinus rhythm.
- AF patients exhibited significantly larger LA volumes and impaired LA function (ejection fraction, reservoir, and contraction strain) compared to normal sinus rhythm.
- HBEA patients showed milder LA structural changes and reduced reservoir strain.
- No significant differences in stroke recurrence or mortality were observed among groups.
Conclusions:
- Cryptogenic stroke patients have a high prevalence of AF and HBEA.
- AF is strongly associated with significant left atrial dysfunction and structural changes.
- HBEA is linked to milder atrial changes.
- Advanced LA echocardiography may guide selection for long-term ECG monitoring in identifying cardiac sources.
Background:
Unknown cardioembolic sources are frequent causes of cryptogenic stroke. We analyzed the risk of atrial fibrillation (AF) or high burden of ectopic atrial activity (HBEA) in patients with cryptogenic stroke, assessing atrial function and 1-year outcomes.
Methods And Results:
The ARIES (Atrial Imaging and Cardiac Rhythm in Cryptogenic Embolic Stroke) study is an observational study including patients with cryptogenic stroke. We analyzed the frequency of AF and HBEA (>3000 atrial ectopic beats/day or >2 bursts or atrial tachycardia between 3 beats and ≤30 seconds) in two 30-day Holter-ECGs, comparing advanced echocardiography signs of left atrial (LA) dysfunction according to rhythm: AF, HBEA, and normal sinus rhythm. We also evaluated 1-year stroke recurrence and mortality. The study included 109 patients; 35 (32.1%) patients had AF, 27 (24.8%) HBEA, and 47 (43.1%) normal sinus rhythm. Compared with those with normal sinus rhythm, patients with AF presented higher 2-dimensional and 3-dimensional LA indexed volumes (38.8±11.2 versus 27.3±11.8 mL/m2, and 50.6±17.2 versus 34.0±15.4 mL/m2, respectively, P<0.001), lower 3-dimensional LA ejection fraction (50±14.6 versus 62.7±11.8, P=0.001), LA reservoir strain (22.0±8.6 versus 30.4±10.5, P<0.001), and LA contraction strain (10.5±8.18 versus 17.1±7.5, P<0.001), remaining significant in multivariate analysis. Patients with HBEA showed higher LA indexed volumes and lower LA reservoir strain than patients with normal sinus rhythm only in univariate analysis. There were no differences in ischemic recurrence or mortality among the groups.
Conclusions:
Patients with cryptogenic stroke showed a high incidence of AF and HBEA. AF is strongly related to LA volume, LA function, and LA reservoir and contraction strain, whereas HBEA showed milder structural changes. Advanced LA echocardiography could help patient selection for long-term ECG monitoring in suspected cardiac sources.
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