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Prognostic value of global left atrial peak strain in patients with acute ischemic stroke and no evidence of atrial fibrillation

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Abstract

Prognostic stratification of acute ischemic stroke (AIS) patients without atrial fibrillation (AF) remains a challenge. Two-dimensional speckle tracking echocardiography (2D-STE) has recently been introduced for dynamic evaluation of left atrial function. However only few data are actually available regarding the application of 2D-STE in AIS patients. The aim of our study was to assess the prognostic role of global left atrial peak strain (GLAPS), measured by 2D-STE, in AIS patients without AF history. Eighty-five AIS patients (mean age 74.1 ± 12.1 years, 49 males) with normal sinus rhythm on ECG and without AF history were enrolled in the prospective study. All patients underwent a complete echocardiographic study with 2D-STE. At 1 year follow-up, we evaluated the occurrence of a composite endpoint of all-cause mortality plus cardiovascular re-hospitalizations. GLAPS was markedly reduced in AIS patients (15.71 ± 4.70%), without any statistically significant difference between the stroke subtypes. At 1-year follow-up, 14 deaths and 17 hospital readmissions were detected in AIS subjects. On a multivariate Cox model, variables independently associated with the occurrence of the composite endpoint were the “Rankin in” Scale (HR 1.69, p = 0.001), GFR (HR 0.98, p = 0.03) and the GLAPS value (HR 0.78, p < 0.0001). A GLAPS value ≤ 15.5% predicted the composite endpoint with sensitivity of 100% and specificity of 80%. A GLAPS value ≤ 15.5% reflects a more advanced atrial cardiomyopathy and might provide a reliable and useful prognostic risk stratification of AIS patients without AF history.

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Authors and Affiliations

  1. Department of Cardiology, Ospedale San Giuseppe MultiMedica, Via San Vittore 12, 20123, Milan, Italy

    Andrea Sonaglioni, Antonio Vincenti, Massimo Baravelli, Elisabetta Rigamonti & Michele Lombardo

  2. Biostatistical Unit, MultiMedica IRCCS, Via Fantoli 16/15, 20138, Milan, Italy

    Elena Tagliabue

  3. Department of Neurology, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy

    Pietro Bassi

  4. Cardiology Clinic, Policlinico San Giorgio, Via Agostino Gemelli 10, 33170, Pordenone, Italy

    Gian Luigi Nicolosi

  5. Cardiovascular Department, MultiMedica IRCCS, Via Milanese 300, 20099, Sesto San Giovanni, Milan, Italy

    Claudio Anzà

  6. Ospedale San Giuseppe Multimedica IRCCS, Via San Vittore 12, 20123, Milan, Italy

    Andrea Sonaglioni

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  1. Andrea Sonaglioni
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Correspondence to Andrea Sonaglioni.

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All procedures performed in the present study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Sonaglioni, A., Vincenti, A., Baravelli, M. et al. Prognostic value of global left atrial peak strain in patients with acute ischemic stroke and no evidence of atrial fibrillation. Int J Cardiovasc Imaging 35, 603–613 (2019). https://doi.org/10.1007/s10554-018-1485-z

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