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Echocardiographic Parameters for Predicting Atrial Fibrillation Following Ischemic Stroke: The PER DIEM
Andy Jiang1, Brian H Buck2, Michael D Hill3
1Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Insights
Atrial fibrillation (AF) detection after ischemic stroke is improved by using echocardiography. Key parameters like left atrial volume index and left ventricular global longitudinal strain can help identify patients needing further monitoring.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Atrial fibrillation (AF) detection post-ischemic stroke is crucial for patient management.
- Echocardiography (echo) is frequently performed after stroke and can identify patients for rhythm monitoring.
- The PER DIEM trial showed implantable loop recorders (ILRs) detect AF more effectively than external monitors.
Purpose of the Study:
- To investigate the association between baseline echocardiographic parameters and the detection of poststroke AF.
- To identify specific echo features that predict AF in patients following an ischemic stroke.
Main Methods:
- A substudy of the PER DIEM trial included patients with complete transthoracic echocardiograms post-ischemic stroke.
- Demographic, clinical, and echocardiographic data were collected and compared between patients with and without AF.
- Statistical analyses were performed to determine associations between echo parameters and AF detection.
Main Results:
- Poststroke AF was detected in 12.4% of the 153 patients studied.
- Patients with AF were older and had higher CHA2DS2-VASc scores.
- Higher left atrial volume index (LAVI) and lower left ventricular global longitudinal strain (LV GLS) were significantly associated with AF detection.
Conclusions:
- Left atrial volume index and LV GLS are significantly associated with subsequent AF detection in ischemic stroke patients.
- These echocardiographic findings can aid in risk stratification for AF monitoring strategies.
- Improved AF detection can lead to more targeted management following ischemic stroke.
Background:
Atrial fibrillation (AF) detection following ischemic stroke is critical to guide management. Echocardiography (echo) is commonly performed poststroke and may help identify candidates for prolonged rhythm monitoring. The PER DIEM trial randomized poststroke patients without known AF to 12-months of implantable loop recorder (ILR) monitoring versus 30-days of external rhythm monitoring and demonstrated higher AF detection rates using ILR.
Aims:
This substudy of the PER DIEM trial investigated the association between baseline echo parameters and poststroke AF detection.
Methods:
PER DIEM trial participants with complete transthoracic echo performed at the time of ischemic stroke were included. Demographic, clinical, and echocardiographic parameters were compared between those with and without AF.
Results:
Nineteen (12.4%) of the 153 patients included had poststroke AF. AF patients were significantly older and had higher CHA2DS2-VASc scores. Patients with AF had higher left atrial volume index (LAVI), lower absolute left ventricular global longitudinal strain (LV GLS) and lower contractile LA strain compared to those without AF. Univariate analysis showed that a higher LAVI (OR 1.30 per 5 mL/m2 increase, 95%CI 1.03-1.64, p = 0.025) and lower absolute LV GLS (OR 2.73 per 5% decrease, 95%CI 1.37-6.04, p = 0.007) were significantly associated with poststroke AF, with optimal cutoff values of 32.12 mL/m2 and 15.5%, respectively.
Conclusions:
In patients with ischemic stroke, LAVI and LV GLS were significantly associated with subsequent AF detection. These findings may help risk stratify AF monitoring strategies for postischemic stroke management.
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