Refining Risk Stratification in Severe Aortic Stenosis With Left Atrial Volume and Atrial Fibrillation

2022 ◽  
Author(s):  
Maciej Kubala ◽  
Yohann Bohbot ◽  
Dan Rusinaru ◽  
Franck Levy ◽  
Sylvestre Maréchaux ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Aortic Stenosis ◽  
Risk Stratification ◽  
Left Atrial ◽  
Severe Aortic Stenosis ◽  
Left Atrial Volume ◽  
Atrial Volume

Abstract WMP65: Prospective Validation of Predictive Features of Paroxysmal Atrial Fibrillation (PROPhecy): An Interim Analysis

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Thalia S Field ◽  
Leah Kuzmuk ◽  
Princess King-Azote ◽  
Samuel Yip ◽  
Jason Andrade
Keyword(s):  
Atrial Fibrillation ◽  
Risk Stratification ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Patient Characteristics ◽  
Cardiac Monitoring ◽  
Volume Index ◽  
Atrial Volume ◽  
Loop Recorder ◽  
Left Atrial Volume Index

Background: Atrial fibrillation (AF) has a distinct antithrombotic regimen for secondary stroke prevention. While 30-day cardiac monitoring has a greater detection rate for AF than 24-hour Holter, it is not widely accessible. Risk stratification may identify patients who could benefit most from prolonged monitoring. PROPhecy aims to prospectively validate predictive features for detection of AF found in EMBRACE, a trial using 30-day monitoring in individuals with an embolic stroke of undetermined source (ESUS). Methods: Participants were > 55 years and within six months of ESUS, without evidence of AF/flutter on 24-hour Holter. All were given an event-triggered external loop recorder for 30 days. Primary outcome was detection of sustained ( > 30 sec) or non-sustained AF/flutter on 30-day monitoring. Results: 150 of a planned 250 participants have completed long-term monitoring to date. Baseline characteristics are compared to EMBRACE (Table 1). Any AF/flutter was detected in 19.3% (EMBRACE, 16.1%). Burden of atrial premature beats in PROPhecy was low in comparison to EMBRACE and did not predict presence of AF on monitoring (Table 2). Left atrial volume index was a significant predictor of AF in both univariable and multivariable regression adjusted for age and sex (OR1.04 per mL/m 2 , 95% 1.01-1.08, p=0.02). Conclusion: Recruitment is ongoing. AF was detected in ~1/5 participants. The burden of atrial ectopy in our cohort is much lower than in EMBRACE despite similar patient characteristics and AF burden. Further work is required to assess the nature of these differences. Left atrial volume index may be helpful for risk stratification.

scholarly journals Atrial fibrillation progression risk factors and associated cardiovascular outcome in well-phenotyped patients: data from the AF-RISK study

EP Europace ◽  
2019 ◽  
Vol 22 (3) ◽  
pp. 352-360 ◽  
Author(s):  
Ruben R De With ◽  
Ernaldo G Marcos ◽  
Elton A M P Dudink ◽  
Henri M Spronk ◽  
Harry J G M Crijns ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Standard Deviation ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Plasminogen Activator Inhibitor 1 ◽  
Atrial Volume ◽  
Standard Deviation Increase ◽  
Recent Onset ◽  
Pai 1

Abstract Aims Atrial fibrillation (AF) is a progressive disease, but identifying patients at risk for AF progression is challenging. We aimed to identify factors associated with AF progression. Methods and results Atrial fibrillation progression was assessed in 392 patients with recent-onset paroxysmal or persistent AF included in the prospective, observational, multicentre identification of a risk profile to guide atrial fibrillation (AF-RISK) study. Progression of AF was assessed by Holter monitoring and 2-week event recorder at baseline and 1-year follow-up. AF progression was defined as: (i) doubling in AF burden at 1 year compared to baseline with a minimum AF burden of 10% in paroxysmal AF; or (ii) transition from paroxysmal to persistent or permanent AF; or (iii) persistent to permanent AF. Age was 60 ± 11 years, 62% were men, and 83% had paroxysmal AF. At 1 year, 52 (13%) had AF progression (11% in paroxysmal; 26% in persistent AF). Multivariable logistic regression showed that left atrial volume [odds ratio (OR) per 10 mL 1.251, 95% confidence interval (CI) 1.078–1.450; P < 0.001], N-terminal pro-B-type natriuretic peptide (NT-proBNP; OR per standard deviation increase 1.583, 95% CI 1.099–2.281; P = 0.014), and plasminogen activator inhibitor-1 (PAI-1; OR per standard deviation increase 0.660, 95% CI 0.472–0.921; P = 0.015) were associated with AF progression. In an additional follow-up of 1.9 (0.9–3.3) years patients with AF progression developed more cardiovascular events and all-cause mortality (12.4%/year vs. 2.3%/year, P < 0.001). Conclusion Atrial fibrillation progression occurred in 13% of patients with recent-onset AF during 1-year follow-up. Left atrial volume, NT-proBNP, and PAI-1 were associated with AF progression. Patients with AF progression had a higher event rate. Trial registration number Clinicaltrials.gov NCT01510210.

Abstract P624: High Detection of Atrial Fibrillation by 90 Days Textil Holter Monitoring in Patients With Cryptogenic Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jorge Pagola ◽  
Jesus Juega ◽  
Jaume Francisco ◽  
Maite Rodriguez ◽  
Juan Antonio Cabezas ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cumulative Incidence ◽  
Left Atrial ◽  
Cryptogenic Stroke ◽  
Left Atrial Volume ◽  
Holter Monitoring ◽  
Cardiac Monitoring ◽  
Atrial Volume ◽  
Monitoring Time ◽  
Number Of Patients

Introduction: External recorders allow for low-cost, non-invasive 1 to 4 weeks monitoring. However, the first 3 months of monitoring duration are the most effective to detect atrial fibrillation (AF). We show the results of the Thunder registry of patients monitored to detect AF during 90 days from the stroke. Methods: A prospective observational study was conducted with consecutive inclusion of patients with cryptogenic stroke after work up (neuroimaging, echocardiography and 24-hour cardiac monitoring) in 5 Comprenhensive Stroke Centers. Patients were continuously monitored for 90 days with a wearable Holter (Nuubo®) after the first 24 hours of the stroke onset. We analyzed the percentage of AF detection in each period (percentage of AF among those monitored), the quality of the monitoring (monitoring time), the percentage of AF by intention to monitor (detection of AF among patient included). Demographic, clinical and echocardiographic predictors of AF detection beyond one week of cardiac monitoring were assessed. Results: A total of 254 patients were included. The cumulative incidence of AF detection at 90 days was 34.84%. The monitoring time was similar among the 3 months (30 days: 544.9 hours Vs 60 days: 505.9 hours Vs 90 days: 591.25 hours) (p=0.512). The number of patients who abandoned monitoring was 7% (18/254). The cumulative percentage of intention to detect AF was 30.88% (Figure). Patients who completed monitoring beyond 30 days had higher score on the NIHSS basal scale (NIHSS 9 IQR 2-17) VS (NIHSS 3 IQR 1-9) (p=0.024). Patients with left atrial volume greater than 28.5ml/m2 had higher risk of cumulative incidence of AF according to the Kaplan Meyer curve beyond the first week of monitoring OR 2.72 (Log-rank (Mantel-Cox test) (p<0.001). Conclusions: In conclusion, intensive 90-day- Holter monitoring with textile Holter was feasible and detected high percentage of AF. Enlarged left atrial volume predicted AF beyond the first week of monitoring.

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