Key result
Echocardiographic measures such as LAVI/A' in the atrial septum predicted unknown atrial fibrillation in stroke/TIA patients with an area under the curve of 0.78 (95% CI 0.63-0.93; p=0.002).
Why the study?
Do echocardiographic measures of atrial function predict unknown atrial fibrillation in patients with prior stroke or TIA?
Cohort (n=174)
Do echocardiographic measures of atrial function predict unknown atrial fibrillation in patients with prior stroke or TIA?
Effect estimate: AUC 0.78 (95% CI 0.63-0.93)
p-value: p=0.002
Echocardiographic measures of left atrial volume and contraction, specifically LAVI and LAVI/A', can predict silent atrial fibrillation in patients following a stroke or TIA.
May support targeted AF monitoring in stroke/TIA patients; hypothesis-generating pending prospective validation.
OBJECTIVE: In patients with a prior stroke or transient ischemic attack (TIA) and atrial fibrillation anticoagulant treatment is indicated. This study's purpose was to investigate if echocardiography can predict unknown AF in patients after stroke. DESIGN: Prospectively, 174 stroke/TIA patients without diagnosed AF underwent echocardiographic evaluation including tissue Doppler imaging (TDI) focusing on functional parameters of the left atrium and left ventricular diastolic function. AF screening was performed during 30 d. RESULTS: Fifteen patients (8.6%) were diagnosed with AF. Echocardiography in the AF group compared to those without AF, showed larger left atrial volume index (LAVI), (37.2 ± 6.7 vs. 31.6 ± 8.6 ml/m(2), p = 0.018), lower A' velocities in ventricular (5.9 ± 2.2 vs. 7.2 ± 1.6, p = 0.010) and atrial (4.8 ± 1.4 vs. 5.9 ± 1.4, p = 0.013) septa, higher LAVI/A' in ventricular septum (6.7 (5.0-8.7) vs. 4.2 (3.2-5.5), p = 0.001) and atrial septum (8.5 (5.9-11.0) vs. 5.1 (4.1-6.8), p = 0.003). Receiver operating characteristic analyses to detect AF was performed, area under the curve for LAVI was 0.71 (0.61-0.83), p = 0.008, and for LAVI/A' in ventricular septum 0.76 (0.59-0.93), p = 0.006 and atrial septum 0.78 (0.63-0.93), p = 0.002, respectively. CONCLUSIONS: LAVI and measures of atrial contraction as measured by TDI predict unknown AF in patients after an stroke/TIA and may be used to detect silent AF.
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Waldenhjort et al. (2016) conducted a cohort in Stroke or transient ischemic attack (TIA) without diagnosed atrial fibrillation (n=174). Echocardiographic measures of atrial function (LAVI and TDI parameters) vs. Patients without atrial fibrillation was evaluated on Detection of unknown atrial fibrillation (AUC 0.78, 95% CI 0.63-0.93, p=0.002). Echocardiographic measures such as LAVI/A' in the atrial septum predicted unknown atrial fibrillation in stroke/TIA patients with an area under the curve of 0.78 (95% CI 0.63-0.93; p=0.002).
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