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Utility of left atrial strain for predicting atrial fibrillation following ischemic stroke

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Abstract

Twenty-five percent of ischemic strokes (IS) are cryptogenic, but it is estimated that paroxysmal atrial fibrillation (PAF) is the underlying cause in up to a third of cases. We aimed to investigate the predictive value of speckle tracking of the left atrium (LA) in diagnosing PAF in IS patients. We retrospectively studied 186 IS patients with a clinical echocardiographic examination during sinus rhythm. Outcome was PAF defined by at least one reported episode of AF following their IS. Conventional echocardiographic measures were performed. Global longitudinal strain (GLS), LA reservoir-(εs), conduit-(εe), contraction-strain (εa) and LA dyssynchrony (standard deviation of time-to-peak εs; LA SD-T2P) were obtained by left ventricular and LA speckle tracking. Of 186 patients, 28 (15%) were diagnosed with PAF. PAF-patients did not differ from non-PAF patients with regards to GLS nor SD-TPS, but atrial strain measures were significantly impaired at baseline (εs 27 vs. 35%, εe 12 vs. 16%, εa 15 vs. 18%, p < 0.02 for all, for PAF and non-PAF, respectively). However, only εs remained independently associated with PAF after adjustment for clinical and echocardiographic parameters (OR 1.13 [1.04; 1.22], p = 0.003, per 1% decrease). εs also provided the highest area under the receiver operating characteristic curve among all variables (AUC = 0.74). With a cutoff of 29%, εs had a specificity of 76% and a negative predictive value of 93%. Atrial reservoir strain is independently associated with PAF and may be used to improve the diagnosis of PAF following IS.

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Funding

Sif Rasmussen received a scholarship grant from Herlev & Gentofte Hospital and the P. Carl Petersens Fond during the preparation of this manuscript.

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Authors and Affiliations

  1. Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, Post 835, 2900, Copenhagen, Denmark

    Sif Maja Aas Rasmussen, Flemming Javier Olsen, Peter Godsk Jørgensen, Thomas Fritz-Hansen & Tor Biering-Sørensen

  2. Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark

    Thomas Jespersen & Tor Biering-Sørensen

  3. Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark

    Gunnar Gislason

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  1. Sif Maja Aas Rasmussen
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  2. Flemming Javier Olsen
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  3. Peter Godsk Jørgensen
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  4. Thomas Fritz-Hansen
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  5. Thomas Jespersen
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  6. Gunnar Gislason
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  7. Tor Biering-Sørensen
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Correspondence to Sif Maja Aas Rasmussen.

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Conflicts of interest

Dr. Biering-Sørensen has received consultant fees from Amgen and Novartis. Dr. Olsen has received a research prize from the Lundbeck Foundation, however, has no collaboration with Lundbeck. None of the companies had any participation in this study.

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Rasmussen, S.M.A., Olsen, F.J., Jørgensen, P.G. et al. Utility of left atrial strain for predicting atrial fibrillation following ischemic stroke. Int J Cardiovasc Imaging 35, 1605–1613 (2019). https://doi.org/10.1007/s10554-019-01601-0

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  • DOI: https://doi.org/10.1007/s10554-019-01601-0

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