Key result
A ~10% lower peak atrial longitudinal strain is linked to silent AF detection in cryptogenic stroke.
Why the study?
Silent AF may cause some cryptogenic strokes, leading investigators to analyse left atrial size and function by speckle tracking echocardiography to detect atrial disease.
Does speckle tracking echocardiography predict the detection of silent atrial fibrillation in patients with cryptogenic stroke?
Cohort (n=75)
Does speckle tracking echocardiography predict the detection of silent atrial fibrillation in patients with cryptogenic stroke?
Absolute Event Rate: 19.6% vs 29.5%
p-value: p=< 0.001
Speckle tracking echocardiography identifies left atrial dysfunction and improves the prediction of silent atrial fibrillation in patients with cryptogenic stroke, even in the absence of atrial enlargement.
May aid silent AF risk stratification in cryptogenic stroke; hypothesis-generating and requires prospective validation before practice change.
Silent atrial fibrillation (AF) may be the cause of some cryptogenic strokes (CrS). The aim of the study was to analyse atrial size and function by speckle tracking echocardiography in CrS patients to detect atrial disease. Patients admitted to the hospital due to CrS were included prospectively. Echocardiogram analysis included left atrial ejection fraction (LAEF) and atrial strain. Insertable cardiac monitor was implanted, and AF was defined as an episode of ≥1 min in the first year after stroke. Left atrial enlargement was defined as indexed volume > 34 mL/m2. Seventy-five consecutive patients were included, aged 76 ± 9 years (arterial hypertension 75%). AF was diagnosed in 49% of cases. The AF group had higher atrial volume and worse atrial function: peak atrial longitudinal strain (PALs) 19.6 ± 5.7% vs. 29.5 ± 7.2%, peak atrial contraction strain (PACs) 8.9 ± 3.9% vs. 16.5 ± 6%, LAEF 46.8 ± 11.5% vs. 60.6 ± 5.2%; p < 0.001. AF was diagnosed in 20 of 53 patients with non-enlarged atrium, and in 18 of them, atrial dysfunction was present. The multivariate logistic regression analysis demonstrated an independent association between detection of AF and atrial volume, LAEF, and strain. Cut-off values were obtained: LAEF < 55%, PALs < 21.4%, and PACs < 12.9%. In conclusion, speckle tracking echocardiography in CrS patients improves silent atrial disease diagnosis, with or without atrial enlargement.
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Blé et al. (2021) conducted a cohort in Cryptogenic stroke (n=75). Speckle tracking echocardiography was evaluated on Peak atrial longitudinal strain (PALs) in patients with vs without detected AF (p=< 0.001). Speckle tracking echocardiography parameters, including peak atrial longitudinal strain (19.6% vs 29.5%; p<0.001), were independently associated with silent AF detection in cryptogenic stroke.
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