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Published on: July 20, 2022
Predicting the Propensity of Atrial Cardiopathy and Paroxysmal Atrial Fibrillation in Patients with Embolic Stroke of
Ahmed Kishk1, Mohamed E Abdeldayem2, Mohamed A Khalil2
1Neuropsychiatry Department, Faculty of Medicine, Tanta University, Tanta - Egito.
Insights
In embolic stroke of undetermined source (ESUS) patients, atrial cardiopathy is common. Hypertension and elevated E/e- ratio predict atrial cardiopathy, while specific echocardiographic measures predict new-onset atrial fibrillation.
Area of Science:
- Cardiology
- Neurology
- Medical Diagnostics
Background:
- A significant portion of embolic stroke of undetermined source (ESUS) patients lack a clear cause.
- Identifying predictors for paroxysmal atrial fibrillation (PAF) is crucial for stroke prevention in ESUS.
Purpose of the Study:
- To evaluate clinical, electrocardiogram, laboratory, and echocardiographic factors predicting paroxysmal atrial fibrillation (PAF) in ESUS patients.
- To identify predictors of atrial cardiopathy in ESUS patients.
Main Methods:
- Seventy-five ESUS patients in sinus rhythm underwent 7-day Holter monitoring, Pro-BNP testing, and echocardiography.
- Statistical analysis used a P-value < 0.05 for significance.
Main Results:
- Hypertension and E/e- ratio > 12 were independent predictors of atrial cardiopathy (p=0.001, p=0.02).
- In patients with atrial cardiopathy, PTFV > 5000 Mv.ms, LA volume index > 34 ml/m2, and ejection fraction < 45% predicted AF (p<0.001 for all).
- Atrial cardiopathy was prevalent in 40/75 ESUS patients; 15/75 had PAF episodes.
Conclusions:
- Atrial cardiopathy is common in ESUS patients.
- Hypertension and E/e- ratio > 12 are independent predictors of atrial cardiopathy.
- Specific echocardiographic parameters (PTFV, LA volume index, ejection fraction) predict new-onset atrial fibrillation in ESUS.
Background:
There is still a significant population of patients with embolic stroke of Undetermined Source (ESUS) whose specific attributable cause of the stroke remains unknown.
Objectives:
Our research aimed to assess clinical, electrocardiogram, laboratory, and echocardiographic parameters that may predict the propensity of paroxysmal atrial fibrillation (PAF).
Methods:
We enrolled seventy-five ESUS patients who were in sinus rhythm at the time of stroke diagnosis to undergo in-hospital 7-day Holter monitoring, testing for Pro-BNP, and a standard echocardiographic examination. For statistical analysis, a P-value < 0.05 was considered significant.
Results:
The average age of the 75 ESUS patients was 58 years old. 60% of the patients were male, and the most prevalent concomitant condition was hypertension (53.3%). Forty patients had atrial cardiopathy, and 15 patients had PAF episodes. Hypertension and the E/e- > 12 were independent predictors of atrial cardiopathy, with p-values of 0.001 and 0.02, respectively. In patients with atrial cardiopathy, multivariable regression analysis was performed; PTFV > 5000 Mv.ms, LA volume index > 34 ml/m2, and ejection fraction < 45% were significant independent predictors of AF with significant p values of 0.001, < 0.001, and 0.001 respectively.
Conclusions:
In ESUS patients, atrial cardiopathy was prevalent. Hypertension and an E/e- ratio greater than 12 were independent predictors for it. Multivariable regression analysis identified PTFV1 > 5000 mV.ms, LA volume index > 34 ml/m2, and ejection fraction < 45% as independent predictors for new-onset atrial fibrillation.
