Association of Left Atrial Sphericity with Risk of Stroke in Patients with Atrial Fibrillation. Sub-Analysis of the ASSAM Study

Abstract Purpose The study was designed to evaluate the value of left atrial (LA) sphericity (LASP) in the identification of patients with atrial fibrillation (AF) who had prior ischemic stroke. The secondary aim was to investigate the possibility of improving stroke risk assessment based on six geometrical variables of LA. Methods This prospective observational study involved 157 patients: 74 in the stroke group and 83 in the control. All patients had cardiac computed tomography (CT) performed to analyze LA volume and dimensions. LASP and the discriminant function of six geometrical measurements were calculated. Results Multivariate logistic regression analysis showed a significant association of stroke with and gender, diabetes, CHA2DS2-VASc score, LA anteroposterior diameter, and LA sphericity. Patients with prior stroke had lower LASP than those without (66.6 ± 10.3% vs. 70.5 ± 7%; p = 0.0062). The most accurate identification of patients with a history of ischemic stroke was achieved by using a function of six geometrical measurements, the sphericity and volume coefficient. The C-statistic was higher for the above discriminant function (0.7273) than for LASP (0.3974). The addition of the discriminant function to the CHA2DS2-VASc score increased the performance of the risk score alone. Conclusion LASP is associated with prior stroke in AF patients. The proposed new formula for identification of AF patients who are at risk of stroke, based on geometrical measurements of LA, is superior to the basic LASP in identification of AF patients with a history of stroke.

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Combined Catheter Ablation and Left Atrial Appendage Closure in Atrial Fibrillation Patients with and without Prior Stroke

Journal of Interventional Cardiology ◽

10.1155/2021/2138670 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Bin-Feng Mo ◽

Rui Zhang ◽

Jia-Li Yuan ◽

Jian Sun ◽

Peng-Pai Zhang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Control Group ◽

Left Atrial Appendage Closure ◽

Combined Procedure ◽

Stroke Group ◽

Prior Stroke

Background. Combined atrial fibrillation (AF) ablation and left atrial appendage closure (LAAC) has been practiced for management of both the symptoms and the high stroke risk of AF. Data of the combined procedure in selected patients with prior stroke are limited. The aim of this study is to compare the safety and efficacy of combined catheter ablation and LAAC between AF patients with and without prior stroke. Methods and Results. This retrospective study enrolled 296 patients who underwent combined procedures of AF ablation and LAAC. Patients were divided into two groups: 81 patients with prior stroke (Stroke group) and 215 patients without prior stroke (Control group). Combined procedures were successfully performed in all the patients. Patients in the Stroke group had higher CHA2DS2-VASc scores (4.9 ± 1.2 vs. 3.2 ± 1.0, P < 0.001 ) and higher HAS-BLED scores (3.5 ± 1.1 vs. 3.0 ± 1.0, P < 0.001 ) compared with those in the Control group. Procedure-related complications in the Stroke group included two pericardial effusions and two groin hematomas, which did not differ significantly fromthe Control group (4.9% vs. 4.2%, P = 0.778 ). After a mean follow-up of 20 months, the AF-free rate of the Stroke group was comparable with that of the Control group (64.2% vs. 68.4%, P = 0.495 ). The relative risk reductions in stroke and bleeding (observed rate compared to that predicted from the CHA2DS2-VASc and HAS-BLED scores) were 80% and 79%, respectively, in the Stroke group, and 62% and 62%, respectively, in the Control group. Conclusions. The combination of catheter ablation and LAAC is safe and efficient in selected AF patients with prior stroke. It was observed that patients with prior stroke may benefit more from risk reductions of stroke and bleeding following the combined procedure.

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High rate of cardiac thrombus diagnosed by adding cardiac imaging in acute stroke computed tomography protocol

International Journal of Stroke ◽

10.1177/1747493020967623 ◽

2020 ◽

pp. 174749302096762 ◽

Cited By ~ 1

Author(s):

Angélique Bernard ◽

Thibault Leclercq ◽

Pierre-Olivier Comby ◽

Gauthier Duloquin ◽

Frédéric Ricolfi ◽

...

Keyword(s):

Computed Tomography ◽

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Stroke ◽

Odds Ratio ◽

Left Atrial ◽

Left Atrial Appendage ◽

Cardiac Computed Tomography ◽

Atrial Appendage ◽

Left Atrial Appendage Thrombus

Background Detection of left atrial appendage thrombus (LAAt) in acute stroke patients can be improved by cardiac computed tomography using prospective electrocardiogram-gated volume acquisition, which was added to the acute stroke computed tomography protocol in our institution in 2018. Aims To evaluate the factors and clinical management associated with LAAt in patients with acute ischemic stroke. Methods We retrospectively included 324 consecutive patients with ischemic stroke from November 2018 to October 2019. Clinical data and post-stroke management were compared in LAAt and no-LAAt patients. Results Thirty-five patients (10.8%; 95%CI 7.4–14.2) had LAAt and 289 had no-LAAt. LAAt patients were significantly older (82 ± 12 vs. 74 ± 14 yo for no-LAAt, p = 0.002), predominantly female (71% vs. 45%, p = 0.004), and were more likely to have previous atrial fibrillation (63% vs. 15%, p < 0.001) and previous stroke (32% vs. 14%, p = 0.005). There was no significant difference between groups in stroke localization or severity scales at admission or at hospital discharge. After multivariable analysis, female sex (odds ratio 2.51; 95%CI 1.09–5.77, p = 0.031), previous atrial fibrillation (odds ratio 4.87; 95%CI 2.11–11.22, p < 0.001), and left atrial volume >86 ml (odds ratio 5.33; 95%CI 1.70–16.69, p = 0.004) were independently associated with LAAt. More than a third of LAAt patients (37%) received acute heparin therapy compared to 13% of no-LAAt patients (p < 0.001). Moreover, despite comparable stroke severity at admission, the mortality rate was markedly higher in the LAAt group than in the no-LAAt group (37% vs. 13%, p < 0.001). Conclusions Cardiac computed tomography for left atrial appendage thrombus evaluation in routine acute stroke imaging protocol could be beneficial for decision-making with regard to the initiation of early anticoagulation.

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Change in Atrial Fibrillation Burden over Time in Patients with Nonpermanent Atrial Fibrillation

Cardiology Research and Practice ◽

10.1155/2020/9583409 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Philipp Krisai ◽

Stefanie Aeschbacher ◽

Matthias Bossard ◽

Elena Herber ◽

Steffen Blum ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Left Atrial Volume ◽

Mixed Effect ◽

Recording Time ◽

Holter Ecg ◽

History Of ◽

Associated Risk Factors ◽

Prior Stroke ◽

Over Time

Introduction. The natural course of atrial fibrillation (AF) is not well defined. We aimed to investigate the change in AF burden over time and its associated risk factors among AF patients. Methods. Fifty-four participants with recently documented paroxysmal or persistent AF were enrolled. Main exclusion criteria were permanent AF or previous catheter ablation for AF. AF burden was calculated as time in AF divided by total recording time using yearly continuous 7-day Holter-ECG recordings. A relative change ≥10% or an absolute change >0.5% in AF burden between two yearly Holter-ECG recordings was considered significant. Results. Mean age was 67 years, 72% were men. The proportion of patients with no recorded AF increased from 53.7% at baseline to 78.6% (p=0.1) after 4 years of follow-up. In 7-day Holter-ECG recordings performed after baseline, 23.7% of participants had a decrease and 23.7% an increase in AF burden. In separate mixed effect models, AF burden over time was associated with prior stroke (β 42.59, 95% CI (23.40; 61.77); p<0.0001), BNP (β 0.05, CI (0.02; 0.09); p=0.005) end-diastolic (β 0.49, CI (0.23; 0.74); p=0.0003) as well as end-systolic (β 0.25, CI (0.05; 0.46); p=0.02) left atrial volume, left atrial ejection fraction (β −0.43, CI (−0.76;−0.10); p=0.01), E-wave (β 36.67, CI (12.96; 60.38); p=0.003), and deceleration time (β −0.1, CI (−0.16; −0.05); p=0.002). In a multivariable model, a history of prior stroke (β 29.87, CI (2.61; 57.13); p=0.03) and BNP levels (β 0.05, CI (0.01; 0.08); p=0.007) remained significantly associated with AF burden. Conclusions. Few patients with paroxysmal or persistent AF have AF episodes on yearly 7-day Holter-ECG recordings, and AF progression is rare. AF burden was independently associated with a history of prior stroke and BNP levels.

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Left Atrial Appendage Closure Yields Favorable Cardio- and Cerebrovascular Outcomes in Patients With Non-valvular Atrial Fibrillation and Prior Stroke

Frontiers in Neurology ◽

10.3389/fneur.2021.784557 ◽

2022 ◽

Vol 12 ◽

Author(s):

Mingzhong Zhao ◽

Mengxi Zhao ◽

Cody R. Hou ◽

Felix Post ◽

Nora Herold ◽

...

Keyword(s):

Atrial Fibrillation ◽

Major Bleeding ◽

Left Atrial ◽

Left Atrial Appendage ◽

Cardiovascular Death ◽

Incidence Rates ◽

Left Atrial Appendage Closure ◽

Previous Stroke ◽

Stroke Group ◽

Prior Stroke

Introduction: Patients with non-valvular atrial fibrillation (NVAF) and previous stroke are at significantly higher risk of stroke recurrence. Data on the efficacy of left atrial appendage closure (LAAC) on these patients is limited. The aim of this study was to investigate the differences of LAAC efficacy on long-term cardio- and cerebrovascular outcomes in NVAF patients with vs. without prior stroke.Methods: Three hundred and seventy consecutive NVAF patients who underwent LAAC were enrolled and divided into stroke and non-stroke groups based on history of previous stroke. Endpoints, such as thromboembolism, major bleeding, and mortality post-LAAC, were followed up among groups.Results: Patients in the stroke group had higher mean CHA2DS2-VASc and HAS-BLED scores compared to the non-stroke group (5.1 vs. 3.6 and 4.1 vs. 3.4, both P < 0.001, respectively). Over a median follow-up of 2.2 years, there were no significant differences in incidence rates of thromboembolism, device-related thrombus (DRT), major bleeding, and combined efficacy endpoints between the two groups. In both stroke and non-stroke groups, LAAC decreased the risk of thromboembolism [relative risk reduction (RRR) 87.5%, P = 0.034, and 74.6%, P = 0.004, respectively] and major bleeding (RRR 68.8%, P = 0.034, and 68.6%, P = 0.007, respectively) compared with predicted risk. The RRR in thromboembolism was greater in patients with vs. without prior stroke (OR 2.45, 95% CI: 1.20–5.12, P = 0.016). The incidence rates of all-cause mortality and non-cardiovascular death were similar between the two groups, but the risks of cardiovascular death post-LAAC both before (1.4% vs. 8.1%, respectively, P = 0.038) and after adjustment for confounding factors (P = 0.048) were significantly decreased in the stroke group.Conclusions: Patients with vs. without prior stroke did not exhibit a worse clinical prognosis after LAAC. LAAC may provide an increased benefit in cardio-cerebrovascular outcomes in patients with previous stroke compared to those without previous stroke. Further research is necessary to evaluate the efficacy of LAAC in this field.

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Predictors of left atrial thrombus in acute ischemic stroke patients without atrial fibrillation: A single-center cross-sectional study

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.66.10.1437 ◽

2020 ◽

Vol 66 (10) ◽

pp. 1437-1443

Author(s):

Tufan Cinar ◽

Mert İlker Hayiroğlu ◽

Vedat Çiçek ◽

Süha Asal ◽

Murat Mert Atmaca ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Left Atrial ◽

Characteristic Curve ◽

Multivariate Logistic Regression Analysis ◽

Single Center ◽

Left Atrial Thrombus ◽

Atrial Thrombus ◽

Cross Sectional

SUMMARY INTRODUCTION: The present study aimed to determine independent predictors of left atrial thrombus (LAT) in acute ischemic stroke (AIS) patients without atrial fibrillation (AF) using transesophageal echocardiography (TEE). METHODS: In this single-center, retrospective study, we enrolled 149 consecutive AIS patients. All of the patients underwent a TEE examination to detect LAT within 10 days following admission. Multivariate logistic regression analysis was performed to assess independent predictors of LAT. RESULTS: Among all cases, 14 patients (9.3%) had a diagnosis of LAT based on the TEE examination. In a multivariate analysis, elevated mean platelet volume (MPV), low left-ventricle ejection fraction (EF), creatinine, and reduced left-atrium appendix (LAA) peak emptying velocity were independent predictors of LAT. The area under the receiver operating characteristic curve analysis for MPV was 0.70 (95%CI: 0.57-0.83; p = 0.011). With the optimal cut-off value of 9.45, MPV had a sensitivity of 71.4% and a specificity of 63% to predict LAT. CONCLUSION: AIS patients with low ventricle EF and elevated MPV should undergo further TEE examination to verify the possibility of a cardio-embolic source. In addition, this research may provide novel information with respect to the applicability of MPV to predict LAT in such patients without AF.

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Post-angiography Retention of the Contrast Agent in the Left Atrial Appendage Is Associated With Risk of Cardioembolic Stroke in Patients With Atrial Fibrillation: A Retrospective Study

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.753949 ◽

2021 ◽

Vol 8 ◽

Author(s):

Ping Fang ◽

Youquan Wei ◽

Jinfeng Wang ◽

Xianghai Wang ◽

Hao Yang

Keyword(s):

Atrial Fibrillation ◽

Retrospective Study ◽

Contrast Agent ◽

Left Atrial ◽

Left Atrial Appendage ◽

Relative Proportion ◽

Multivariate Logistic Regression Analysis ◽

Atrial Appendage ◽

Cardioembolic Stroke ◽

Stroke Group

Background: Atrial fibrillation (AF) represents an important risk factor for cardioembolic stroke, and most atrial thrombi originate from the left atrial appendage (LAA). Although the CHA2DS2-VASc score is widely used to estimate the risk of cardioembolic stroke in AF patients, yet greatly affected by many factors. This study was undertaken to determine the association between contrast agent retention in LAA after LAA angiography and risks of cardioembolic stroke in patients with AF.Methods: This is a retrospective study. The demographic and clinical data of AF patients undergone left atrial appendage occlusion (LAAO) with or without catheter radiofrequency ablation were retrospectively analyzed. The patients were classified into either stroke or non-stroke group by the history with cardioembolic stroke or transient ischemic attack (TIA).Results: Sixty-two consecutive patients undergone LAAO were finally included, in whom 31 AF patients had a history of cardioembolic stroke or TIA (one TIA), and significantly higher CHA2DS2-VASc score (4.2 ± 1.4 vs. 3.3 ± 1.3; P = 0.006) as well as incidence of contrast agent retention in LAA (n = 20 vs. n = 7; P = 0.001) compared to the patients in non-stroke group. In addition, the relative proportion of distinctive morphological types of LAA was significantly different between groups (P < 0.001). Multivariate logistic regression analysis showed that higher CHA2DS2-VASc scores (OR = 1.7, 95% CI: 1.0–3.0, P = 0.046) and LAA contrast agent retention (OR = 5.1, 95% CI: 1.1–23.9, P = 0.002) were associated with increased risks of cardioembolic stroke. The patients with Windsock type LAA (OR = 7.8, 95% CI: 1.1–57.2, P = 0.044) and Cauliflower LAA (OR = 20.2, 95% CI: 3.2–125.5, P = 0.001) were more prone to cardioembolic stroke compared to those with Chicken Wing type LAA.Conclusion: Left atrial appendage contrast agent retention after LAA angiography is associated with the risks of cardioembolic stroke in patients with AF, and cardioembolic stroke is more seen in AF patients with Windsock or Cauliflower type LAA.

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The Role of HbA1c on Mortality in Patients with Medical History of Ischemic Stroke and Paroxysmal Atrial Fibrillation

Diabetes ◽

10.2337/db18-2406-pub ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 2406-PUB

Author(s):

KONSTANTINA KANELLOPOULOU ◽

IOANNIS L. MATSOUKIS ◽

ASIMINA GANOTOPOULOU ◽

THEODORA ATHANASOPOULOU ◽

CHRYSOULA TRIANTAFILLOPOULOU ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Medical History ◽

Paroxysmal Atrial Fibrillation ◽

History Of

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High Risk of One-year Stroke Recurrence in Patients with Younger Age and Prior History of Ischemic Stroke

Current Neurovascular Research ◽

10.2174/1567202616666190618164528 ◽

2019 ◽

Vol 16 (3) ◽

pp. 250-257 ◽

Cited By ~ 1

Author(s):

Jiann-Der Lee ◽

Ya-Han Hu ◽

Meng Lee ◽

Yen-Chu Huang ◽

Ya-Wen Kuo ◽

...

Keyword(s):

Logistic Regression ◽

Ischemic Stroke ◽

Multivariate Logistic Regression Analysis ◽

Stroke Recurrence ◽

Prior History ◽

Multivariate Logistic Regression ◽

Cart Analysis ◽

Younger Age ◽

History Of ◽

One Year

Background and Purpose: Recurrent ischemic strokes increase the risk of disability and mortality. The role of conventional risk factors in recurrent strokes may change due to increased awareness of prevention strategies. The aim of this study was to explore the potential risk factors besides conventional ones which may help to affect the advances in future preventive concepts associated with one-year stroke recurrence (OSR). Methods: We analyzed 6,632 adult patients with ischemic stroke. Differences in clinical characteristics between patients with and without OSR were analyzed using multivariate logistic regression and classification and regression tree (CART) analyses. Results: Among the study population, 525 patients (7.9%) had OSR. Multivariate logistic regression analysis revealed that male sex (OR 1.243, 95% CI 1.025 – 1.506), age (OR 1.015, 95% CI 1.007 - 1.023), and a prior history of ischemic stroke (OR 1.331, 95% CI 1.096 – 1.615) were major factors associated with OSR. CART analysis further identified age and a prior history of ischemic stroke were important factors for OSR when classified the patients into three subgroups (with risks of OSR of 8.8%, 3.8%, and 12.5% for patients aged > 57.5 years, ≤ 57.5 years/with no prior history of ischemic stroke, and ≤ 57.5 years/with a prior history of ischemic stroke, respectively). Conclusions: Male sex, age, and a prior history of ischemic stroke could increase the risk of OSR by multivariate logistic regression analysis, and CART analysis further demonstrated that patients with a younger age (≤ 57.5 years) and a prior history of ischemic stroke had the highest risk of OSR.

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Comparison of Left Atrial Appendage Occlusion versus Non-Vitamin-K Antagonist Oral Anticoagulation in High-Risk Atrial Fibrillation: An Update

Journal of Cardiovascular Development and Disease ◽

10.3390/jcdd8060069 ◽

2021 ◽

Vol 8 (6) ◽

pp. 69

Author(s):

Shaojie Chen ◽

K. R. Julian Chun ◽

Zhiyu Ling ◽

Shaowen Liu ◽

Lin Zhu ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

High Risk ◽

Vitamin K ◽

Major Bleeding ◽

Left Atrial ◽

Left Atrial Appendage ◽

Vitamin K Antagonists ◽

Left Atrial Appendage Occlusion ◽

The Mean

Transcatheter left atrial appendage occlusion (LAAO) is non-inferior to vitamin K antagonists (VKAs) in preventing thromboembolic events in atrial fibrillation (AF). Non-vitamin K antagonists (NOACs) have an improved safety profile over VKAs; however, evidence regarding their effect on cardiovascular and neurological outcomes relative to LAAO is limited. Up-to-date randomized trials or propensity-score-matched data comparing LAAO vs. NOACs in high-risk patients with AF were pooled in our study. A total of 2849 AF patients (LAAO: 1368, NOACs: 1481, mean age: 75 ± 7.5 yrs, 63.5% male) were enrolled. The mean CHA2DS2-VASc score was 4.3 ± 1.7, and the mean HAS-BLED score was 3.4 ± 1.2. The baseline characteristics were comparable between the two groups. In the LAAO group, the success rate of device implantation was 98.8%. During a mean follow-up of 2 years, as compared with NOACs, LAAO was associated with a significant reduction of ISTH major bleeding (p = 0.0002). There were no significant differences in terms of ischemic stroke (p = 0.61), ischemic stroke/thromboembolism (p = 0.63), ISTH major and clinically relevant minor bleeding (p = 0.73), cardiovascular death (p = 0.63), and all-cause mortality (p = 0.71). There was a trend toward reduction of combined major cardiovascular and neurological endpoints in the LAAO group (OR: 0.84, 95% CI: 0.64–1.11, p = 0.12). In conclusion, for high-risk AF patients, LAAO is associated with a significant reduction of ISTH major bleeding without increased ischemic events, as compared to “contemporary NOACs”. The present data show the superior role of LAAO over NOACs among high-risk AF patients in terms of reduction of major bleeding; however, more randomized controlled trials are warranted.

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