Key result
Total atrial conduction time predicts ~94% higher ischemic stroke risk per 10 ms increase.
Why the study?
Total atrial conduction time (TACT) predicts AF risk, but whether adding TACT to the revised Framingham stroke risk profile (rFSRP) improves stroke risk prediction in patients without prior stroke or known AF remained unknown.
Does adding total atrial conduction time (TACT) to the revised Framingham stroke risk profile improve the prediction of ischemic stroke in patients without prior stroke or known atrial fibrillation?
Cohort (n=376)
No
Does adding total atrial conduction time (TACT) to the revised Framingham stroke risk profile improve the prediction of ischemic stroke in patients without prior stroke or known atrial fibrillation?
Adding echocardiography-derived total atrial conduction time to the revised Framingham stroke risk profile significantly improves the prediction of ischemic stroke in patients without prior stroke or atrial fibrillation.
Answers are grounded in this paper and cite their sources.
TACT may enhance stroke prediction beyond Framingham score in sinus-rhythm patients; leaves open prospective validation before clinical adoption.
The total atrial conduction time (TACT) measured by echocardiography predicts the risk of atrial fibrillation (AF). This study aimed to investigate whether adding the TACT to the revised Framingham stroke risk profile (rFSRP) improves the efficacy of predicting stroke incidence in patients without prior stroke or known AF. The TACT was measured in 376 consecutive patients > 18 years (58.5 ± 16.3 years; 46% male) receiving echocardiography without any prior history of stroke or AF. The primary endpoint was the occurrence of ischemic stroke, and the secondary endpoint was any documentation of AF during the 2 years of follow-up. During the follow-up period, ischemic strokes occurred in 10 patients (2.65%), and AF in 22 patients (5.85%). The TACT was significantly longer in those who later had a stroke compared with those who did not (169.4 vs. 142.7 ms, p < 0.001). Both rFSRP and TACT predicted the risk for stroke incidence. The univariate model showed that the TACT was a predictor of ischemic stroke incidence (p < 0.001; hazard ratio of 1.94 for every 10 ms; 95% confidence interval, 1.49-2.54). The addition of TACT to rFSRP significantly improved the area under the receiver operating characteristic curve (0.79 vs. 0.85, p = 0.001). Stroke risk prediction was significantly improved by the addition of TACT to rFSRP. The utility of the TACT should be further investigated in large-scale randomized clinical trials.
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Bejinariu et al. (2022) conducted a cohort in Sinus rhythm without prior stroke or known atrial fibrillation (n=376). Total atrial conduction time (TACT) measurement was evaluated on Occurrence of ischemic stroke (HR 1.94, 95% CI 1.49-2.54, p=<0.001). Total atrial conduction time significantly predicted ischemic stroke (HR 1.94 per 10 ms increase) and improved the predictive accuracy of the revised Framingham stroke risk profile.
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