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Published on: February 26, 2013
Left atrial volumetric/mechanical coupling index and atrial fibrillation in the embolic stroke of undetermined source
Giacomo Mugnai1, Alberto Comuzzi1, Sara De Giovanni1
1Division of Cardiology, Cardio-Thoracic Department.
Insights
Predicting atrial fibrillation in embolic stroke of undetermined source (ESUS) is challenging. The left atrial volumetric/mechanical coupling index (LACI) shows promise as a predictor, aiding in identifying patients at higher risk.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Predicting atrial fibrillation in patients with embolic stroke of undetermined source (ESUS) remains a clinical challenge.
- Echocardiographic parameters are being investigated as potential predictors for atrial fibrillation in ESUS patients.
- The left atrial volumetric/mechanical coupling index (LACI), derived from left atrial volume and tissue Doppler imaging (TDI) a', serves as a surrogate for left atrial function.
Purpose of the Study:
- To evaluate the left atrial volumetric/mechanical coupling index (LACI) as a predictor of atrial fibrillation in patients with ESUS.
- To determine the association between LACI and the occurrence of atrial fibrillation in ESUS patients undergoing implantable loop recorder (ILR) monitoring.
Main Methods:
- Retrospective analysis of 129 ESUS patients who underwent ILR implantation between 2017 and 2022.
- Patients were followed for a minimum of 6 months via remote monitoring and telephone visits.
- Multivariate analysis was performed to assess the independent association of LACI with atrial fibrillation.
Main Results:
- Patients who developed atrial fibrillation had significantly higher baseline LACI values (5.53 ± 2.52) compared to those who did not (3.25 ± 1.19).
- LACI was independently and significantly associated with atrial fibrillation (Hazard Ratio = 1.21, P < 0.01).
- The optimal cut-off value for LACI to predict atrial fibrillation was determined to be 4.24.
Conclusions:
- The study confirms that LACI is an independent predictor of atrial fibrillation in ESUS patients.
- LACI provides valuable prognostic information beyond traditional clinical and echocardiographic factors.
- This index may aid in risk stratification and management of ESUS patients.
Introduction:
Nowadays, no clear predictors of atrial fibrillation in patients with embolic stroke of undetermined source (ESUS) are known. Some echocardiographic parameters have been proposed as potential predictors of atrial fibrillation in patients with ESUS. The ratio between left atrial volume and tissue Doppler (TDI) a' provides the left atrial volumetric/mechanical coupling index (LACI) and represents a feasible surrogate for left atrial function, and might be useful to identify atrial fibrillation in this subset of patients.
Methods And Results:
All consecutive patients having undergone an implantable loop recorder (ILR) for ESUS between 2017 and 2022 were retrospectively enrolled. All patients were followed through remote monitoring and telephone visit for a minimum follow-up of 6 months.A total number of 129 patients (mean age: 72.2 ± 8.8 years; 55% of men) were analyzed. Patients developing atrial fibrillation presented higher baseline LACI (5.53 ± 2.52 vs. 3.25 ± 1.19, P < 0.001). The multivariate analysis showed that LACI was independently and significantly associated with atrial fibrillation (hazard ratio = 1.21, 95% confidence interval 1.09-1.32, P < 0.01). The best cut-off value of LACI was found to be 4.24.
Discussion:
Our data confirm that LACI is independently associated with atrial fibrillation in patients with ILR following ESUS, accounting for clinical or echocardiographic factors.
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