Elevated BNP (HR 3.3; 95% CI 1.9-5.9), LAVI (HR 3.0; 95% CI 1.6-5.8), and excessive supraventricular ectopic activity (HR 2.5; 95% CI 1.2-4.9) were significantly associated with 3-year AF risk.
RCT (n=398)
randomized
Do established markers of left atrial cardiomyopathy predict the 3-year risk of atrial fibrillation in patients with ischemic stroke?
Left atrial volume index, brain natriuretic peptide, and excessive supraventricular ectopic activity are significant independent predictors of atrial fibrillation in patients with ischemic stroke.
Absolute Event Rate: 15% vs 11%
Abstract Background Parameters indicating the presence of left atrial cardiomyopathy (LACMP) reflect echocardiographic, neurohumoral and electrophysiological alterations of the left atrial myocardium. These parameters have been shown to be associated with an increased risk of atrial fibrillation (AF) in stroke patients in predominantly univariate analyses. Comparative and multivariable investigations regarding the prevalence and association of individual LACMP parameters with AF risk are lacking. Objective To compare established markers of LACMP with the three-year risk of AF in ischemic stroke patients. Methods and Results 398 ischemic stroke patients in the Find-AFrandomised trial (mean age 73±7 years, 40% female) were randomized to either intensified rhythm monitoring by means of repetitive 10-day-Holter-ECG or usual care and followed for 3 years1. The association of the established LACMP parameters left atrial volume index (LAVI) 35 ml/m², P-terminal force in lead V1 (PTFV1) 4000 ms*µV, elevated brain natriuretic peptide (BNP) ≥100 pg/ml and excessive supraventricular ectopic activity with AF risk was analyzed using Kaplan-Meier plots with log-rank tests and a multivariable model considering all four parameters2. 219 patients (55%) had no signs of LACMP. We found one, two and three positive LACMP parameters in 134 patients (34%), 39 (10%) and six (1%) patients, respectively. After three years of follow up, AF was detected in 51/398 (13%) patients (intervention arm 15%, control arm 11 %). In patients with at least one LACMP parameter 33/179 (18%) had AF and in patients without any LACMP parameter, AF was detected in 18/219 (8%) (p=.003). AF detection rates were significantly different in patients with and without ESVEA (28% vs. 11%, p=.003), elevated BNP (29% vs. 10%, p.001) and LAVI (31% vs. 11%, p.001) but not in patients with and without elevated PTFV1 (9% vs 14%, p=.134, see Figure 1). In a multivariable cox regression model considering the above-mentioned parameters, BNP (HR 3.3, 95%CI 1.9-5.9), LAVI (HR 3.0, 95%CI 1.6-5.8), ESVEA (HR 2.5, 95%CI 1.2-4.9) were significantly associated with detection of AF, but PTFV1 (HR 0.5, 95%CI 0.2-1.1) was not. Conclusion In a comparative analysis of four components of left atrial cardiomyopathy in stroke patients, only left atrial volume index, brain natriuretic peptide and excessive supraventricular ectopic activity proved to be significantly associated with AF risk. Figure 1: AF detection rate according to numbers of positive LACMP components and indivual positive LACMP components. AF= Atrial Fibrillation. LACMP=left atrial cardiomyopathy. BNP=brain natriuretic peptide. LAVI=left atrial volume index. PTFV1=P-terminal force in lead V1.Figure 1
Schroeder et al. (Sat,) conducted a rct in Ischemic stroke (n=398). Intensified rhythm monitoring vs. Usual care was evaluated on Detection of atrial fibrillation. Elevated BNP (HR 3.3; 95% CI 1.9-5.9), LAVI (HR 3.0; 95% CI 1.6-5.8), and excessive supraventricular ectopic activity (HR 2.5; 95% CI 1.2-4.9) were significantly associated with 3-year AF risk.