Key result
An interatrial electromechanical delay cutoff of 78.5 ms predicted TIA/stroke in patients with paroxysmal atrial fibrillation with 89.2% sensitivity and 84.1% specificity.
Why the study?
The study was conducted to investigate the relationship between atrial electromechanical delay and transient ischemic attack or stroke in patients with paroxysmal atrial fibrillation.
Is prolonged atrial electromechanical delay associated with transient ischemic attack or stroke in patients with paroxysmal atrial fibrillation?
Case-Control (n=222)
No
Is prolonged atrial electromechanical delay associated with transient ischemic attack or stroke in patients with paroxysmal atrial fibrillation?
p-value: p=0.05
Prolonged interatrial and intra-left atrial electromechanical delay measured by tissue Doppler echocardiography is associated with an increased risk of TIA/stroke in patients with paroxysmal atrial fibrillation.
May identify higher TIA/stroke risk in PAF; hypothesis-generating and requires prospective validation before clinical use.
Objective This study was to investigate the relationship between atrial electromechanical delay and transient ischemic attack (TIA) / stroke in patients with paroxysmal atrial fibrillation (PAF). Methods We selected the patients diagnosed with PAF in Renmin Hospital of Wahan University from October 2015 to May 2018.The patients were divided into TIA/stroke group(n=65) and no TIA/stroke group(n=157) according to whether the patients had TIA/stroke or not.Echocardiography was used to measure the left atrial diameter, left ventricular end-diastolic diameter, and left ventricular end-systolic diameter in both groups.Tissue Doppler was used to measure electromechanical delay time(EMD) at the lateral mitral annulus, septal mitral annulus and the tricuspid annulus.EMD was the time interval from the onset of the P wave to the beginning of the late diastolic A’ wave.Interatrial EMD was the difference between PA’ lateral and PA’ tricuspid.Intra-right atrial EMD was the difference between PA’ septal and PA’ tricuspid.Intra-left atrial EMD was the difference between PA’ septal and PA’ lateral.The differences between the two groups were compared and the relationship between each index and TIA/stroke was explored. Results Compared with the TIA/stroke-free group, the left atrial diameter [(44.6±3.7) mm vs.(40.4±4.4) mm], left ventricular end-diastolic diameter[(48.3±3.6) mm vs.(45.1±3.5) mm], and left ventricular end-systolic diameter[(34.6±3.0) mm vs.(31.5±3.6) mm], mitral annulus EMD[(130.0±2.7) ms vs.(115±6.5) ms], interatrial EMD [(89.1±8.4) ms vs.(70.0±7.9) ms], left atrial EMD[(68.0±6.3) ms vs.(48.8±9.5) ms] in the TIA/stroke group were increased significantly (P 0.05). The optimal cutoff for interatrial EMD to predict TIA/stroke in paroxysmal atrial fibrillation was 78.5 ms(sensitivity, 89.2%; specificity, 84.1%). The optimal cutoff for intra-left atrial EMD to predict TIA/stroke in PAF was 60.5 ms (sensitivity 90.8%; specificity 87.3%). Conclusion As with the CHA2DS2-VASc score, the extension of interatrial EMD and the intra-left atrial EMD in patients with PAF is associated with TIA/stroke.The assessment of this parameter in patients with PAF may contribute to the identification of high-risk patients with the TIA/ stroke.
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Wang et al. (2019) conducted a case-control in Paroxysmal atrial fibrillation (n=222). Prolonged atrial electromechanical delay vs. Normal atrial electromechanical delay was evaluated on TIA/stroke (p=0.05). An interatrial electromechanical delay cutoff of 78.5 ms predicted TIA/stroke in patients with paroxysmal atrial fibrillation with 89.2% sensitivity and 84.1% specificity.
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