Left atrial appendage reservoir strain significantly predicted subclinical atrial fibrillation in ESUS patients, demonstrating an AUC of 0.80 (95% CI 0.73-0.87; P<0.001).
Cohort (n=185)
Does left atrial appendage strain predict subclinical atrial fibrillation in patients with embolic strokes of undetermined source?
Left atrial appendage strain and mechanical dispersion assessed by echocardiography are strong, independent predictors of subclinical atrial fibrillation in patients with embolic strokes of undetermined source.
Effect estimate: AUC 0.80 (95% CI 0.73-0.87)
p-value: p=<0.001
Abstract Aims Left atrial (LA) strain is promising in prediction of clinical atrial fibrillation (AF) in stroke patients. However, prediction of subclinical AF is critical in patients with embolic strokes of undetermined source (ESUS). The aim of this prospective study was to investigate novel LA and left atrial appendage (LAA) strain markers in prediction of subclinical AF in ESUS patients. Methods and results A total of 185 patients with ESUS, mean age 68 ± 13years, 33% female, without diagnosed AF, were included. LAA and LA function by conventional echocardiographic parameters and reservoir strain (Sr), conduit strain (Scd), contraction strain (Sct), and mechanical dispersion (MD) of Sr were assessed with transoesophageal and transthoracic echocardiography. Subclinical AF was detected by insertable cardiac monitors during follow-up. LAA strain was impaired in 60 (32%) patients with subclinical AF compared to those with sinus rhythm: LAA-Sr, 19.2 ± 4.5% vs. 25.6 ± 6.5% (P 0.001); LAA-Scd, −11.0 ± 3.1% vs. −14.4 ± 4.5% (P 0.001); and LAA-Sct, −7.9 ± 4.0% vs. −11.2 ± 4% (P 0.001), respectively, while LAA-MD was increased, 34 ± 24 ms vs. 26 ± 20 ms (P = 0.02). However, there was no significant difference in phasic LA strain or LA-MD. By ROC analyses, LAA-Sr was highly significant in prediction of subclinical AF and showed the best AUC of 0.80 (95% CI 0.73–0.87) with a sensitivity of 80% and a specificity of 73% (P 0.001). LAA-Sr and LAA-MD were both independent and incremental markers of subclinical AF in ESUS patients. Conclusion LAA function by strain and mechanical dispersion predicted subclinical AF in ESUS patients. These novel echocardiographic markers may improve risk stratification in ESUS patients.
Saberniak et al. (Fri,) conducted a cohort in Embolic strokes of undetermined source (ESUS) (n=185). Left atrial appendage (LAA) strain and mechanical dispersion assessment was evaluated on Subclinical atrial fibrillation (AUC 0.80, 95% CI 0.73-0.87, p=<0.001). Left atrial appendage reservoir strain significantly predicted subclinical atrial fibrillation in ESUS patients, demonstrating an AUC of 0.80 (95% CI 0.73-0.87; P<0.001).
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