The echocardiographic parameter LAVi/A demonstrated a significantly higher AUC than LAVi alone (0.785 vs 0.696, P<0.01) for diagnosing cardioembolic stroke due to underlying atrial fibrillation.
Case-Control (n=380)
Do echocardiographic parameters of left atrial remodeling (LAVi/A and E/A ratio) accurately distinguish cardioembolic stroke due to underlying atrial fibrillation in acute stroke patients presenting in sinus rhythm?
Echocardiographic parameters, specifically LAVi/A and the E/A ratio, can reliably help identify underlying atrial fibrillation as the etiology of cardioembolic stroke in acute stroke patients presenting in sinus rhythm.
Estimación del efecto: AUC 0.785
valor p: p=<0.01
INTRODUCTION: Atrial remodeling due to high-burden atrial fibrillation (AF) is associated with cardioembolic stroke (CES). As not all CESs is caused by AF, we analyzed the diagnostic values of each echocardiographic parameter to distinguish likely AF-related CES in acute stroke patients while in non-AF rhythm. METHODS: The data of consecutive patients with acute ischemic stroke in sinus rhythm between 2012 and 2015 were obtained. The echocardiographic parameters of patients with CES due to underlying AF (n = 61) and control patients (n = 319) with either large artery atherosclerosis or small-vessel occlusion were compared using receiver operating characteristic curves and logistic regression analyses. Each parameter was reassessed in acute stroke patients through a validation study using the same database with different periods of generalization. RESULTS: CES patients with underlying AF showed a significantly larger left atrial volume index (LAVi), higher mitral inflow E wave (E), and lower A wave (A) than the controls. The area under the curve (AUC) (95% confidence interval) for diagnosing CES due to underlying AF was significantly higher for LAVi/A than for LAVi (0.785 versus 0.696, P 60 years, the E/A ratio had the highest AUC (0.857) of the parameters. The cut-off values were ≥ 0.70 (sensitivity, 55.7%; specificity, 90.9%) and ≥ 0.82 (sensitivity, 71.4%; specificity, 84.1%) for LAVi/A and the E/A ratio, respectively, in patients >60 years. The cut-off values of all parameters showed similar trends in a validation study. CONCLUSION: LAVi/A is a useful indicator for distinguishing CES patients with underlying AF regardless of age, and the E/A ratio is reliable among patients aged >60 years in evaluation during acute stroke admission.
Shimamoto et al. (Mon,) conducted a case-control in Acute ischemic stroke in sinus rhythm (n=380). Echocardiographic parameters (LAVi/A and E/A ratio) vs. Controls with large artery atherosclerosis or small-vessel occlusion was evaluated on Diagnosis of cardioembolic stroke due to underlying atrial fibrillation (AUC 0.785, p=<0.01). The echocardiographic parameter LAVi/A demonstrated a significantly higher AUC than LAVi alone (0.785 vs 0.696, P<0.01) for diagnosing cardioembolic stroke due to underlying atrial fibrillation.