Atrial Electromechanical Interval May Predict Cardioembolic Stroke in Apparently Low Risk Elderly Patients with Paroxysmal Atrial Fibrillation

Yoko Hoshi; Yukinaga Nozawa; Makoto Ogasawara; Satoshi Yuda; Ai Sato; Takuya Sakasai; Makoto Oka; Harumi Katayama; Masaya Sato; Hidemichi Kouzu; Masahiro Nishihara; Atsushi Doi; Takatoshi Nishimiya; Tetsuji Miura

doi:10.1111/echo.12329

July 30, 2013EchocardiographyOpen Access

Atrial Electromechanical Interval May Predict Cardioembolic Stroke in Apparently Low Risk Elderly Patients with Paroxysmal Atrial Fibrillation

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Why the study?

Does the atrial electromechanical interval (AEMI) improve the prediction of cardioembolic stroke in patients with paroxysmal atrial fibrillation, particularly those with a low CHADS2 score?

Structured PICO

Does the atrial electromechanical interval (AEMI) improve the prediction of cardioembolic stroke in patients with paroxysmal atrial fibrillation, particularly those with a low CHADS2 score?

P

Population

160 subjects, including 108 patients with nonvalvular paroxysmal atrial fibrillation (PAF) and 52 healthy controls.

I

Intervention

Measurement of atrial electromechanical interval (AEMI) via echocardiography

C

Comparator

Left atrial volume index (LAVI) and peak myocardial velocity during late diastole (a')

O

Outcome

History of cardioembolic stroke (CE)hard clinical

Prolonged atrial electromechanical interval (>82 msec) is independently associated with a history of cardioembolic stroke in patients with paroxysmal atrial fibrillation, even among those with a low CHADS2 score.

Implication

Prolonged AEMI may flag prior stroke in low-CHADS2 PAF; leaves open prospective validation for improved prediction.

Abstract

BACKGROUND: A considerable number of patients with atrial fibrillation (AF) develop cardioembolic stroke (CE) despite low CHADS2 score. We examined the possibility that use of the atrial electromechanical interval (AEMI) improves prediction of CE in patients with paroxysmal AF (PAF), particularly those with low CHADS2 score. METHODS: We consecutively enrolled 108 patients with nonvalvular PAF and 52 healthy subjects as controls. The PAF patients were divided into 2 groups depending on presence (n = 36) or absence (n = 72) of the history of CE. Left atrial (LA) volume index (LAVI), peak myocardial velocity during late diastole (a'), and AEMI as time from onset of P-wave to onset of lateral a' were measured. RESULTS: Patients with PAF had significantly larger LAVI, longer AEMI, and lower lateral a' than those in controls. Area under the curves for LAVI, lateral a', and AEMI for identifying patients with PAF were 0.70, 0.69, and 0.88, respectively. Multivariate logistic regression analysis indicated that age, use of antiarrhythmic drugs, and AEMI, but not LAVI or a', were independently associated with history of CE in patients with PAF. PAF patients were categorized into low risk by CHADS2 score (i.e. CHADS2 score = 0 or 1, n = 60), those with prolonged AEMI (>82 msec) had significantly higher rates of CE than those with ≤ 82 msec (48% vs. 15%, P < 0.05). CONCLUSION: As compared with echocardiographic parameters of LA size and LA function, AEMI appears to be more useful for identifying PAF patients. AEMI may enable to detect high risk PAF patients, especially those categorized into low risk by CHADS2 score.