scholarly journals Major impact of left auricular cardiopathy when associated to supraventricular ectopy?

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
C Marques Pires ◽  
AR Silva ◽  
P Medeiros ◽  
I Campos ◽  
C Oliveira ◽  
...  
Keyword(s):  
Diagnostic Test ◽  
Test Performance ◽  
Left Atrial ◽  
Cox Regression ◽  
Composite Endpoint ◽  
Embolic Stroke ◽  
P Wave ◽  
Stroke Recurrence ◽  
Diagnostic Test Performance ◽  
The Impact

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION Left atrial cardiopathy (LAC) is an independent predictor of atrial fibrillation (FA) and embolic stroke. It is more frequent in patients with embolic stroke of undetermined source (ESUS) than in non-embolic strokes. The current definition doesn’t include supraventricular ectopy. AIM The aim of this work was to describe the importance of LAC in ESUS and to study the impact of adding the number of atrial premature complexes per hour (APC/h) to LAC criteria. METHODS Retrospective analysis of 123 ESUS patients (pts) admitted to Neurology service from 2014 to 2019. LAC was defined according to two criteria (LAC2: severe left atrial enlargement or p-wave terminal force in lead V1 [PTFV1] >5000 µV*ms) or 3 criteria (LAC3: additionally, >30 APC/h). Survival analysis for the occurrence of AF, stroke recurrence and death according to LAC2 and LAC3. Diagnostic test performance analysis for each criterion with ROC curves. RESULTS 43 (35%) of the ESUS pts had LAC2. Pts with LAC2 (35.0%) were older (p = 0.007), more frequently had hypertension (p = 0.004) and lower total cholesterol levels (p = 0.044) than patients without LAC2. The incidence of AF (median follow-up 21 months, IQR = 9-35) was higher both in LAC2 (p = 0.038) and LAC3 (p = 0.001). There were no differences in stroke recurrence or death between patients with or without LAC2 or 3. Among the 3 atrial dysfunction criteria included in LAC3 definition, the number of APC/h was associated with a higher area under the curve for the occurrence of AF (AUC = 0.822). Cox regression revealed that PTFV1 > 5000 µV·ms (HR = 5.12, IC95%=1.28-20.56, p = 0.021) and >30 APC/h (HR = 13.02, IC95%=3.57-47.56) were independent predictors of AF. In addition, the single predictor of the composite endpoint (occurrence of AF, stroke recurrence and death) was >30 APC/h (HR = 5.2, p < 0,001). CONCLUSION In ESUS pts, the subgroup with LAC2 had different clinical characteristics and a higher AF incidence. APC/h were also independently associated with AF incidence and had better diagnostic test performance than the other criteria. In sum, APC/h inclusion as a diagnostic criterion for LAC should be considered and may help in a better therapeutic approach.

The Impact of Patient Characteristics on Diagnostic Test Performance

Small Methods ◽  
2022 ◽  
pp. 2101233
Author(s):  
Hannah N. Kozlowski ◽  
Shrey Sindhwani ◽  
Warren C. W. Chan
Keyword(s):  
Diagnostic Test ◽  
Test Performance ◽  
Patient Characteristics ◽  
Diagnostic Test Performance ◽  
The Impact

Abstract TP428: Missed Opportunities for Secondary Stroke Prevention in Embolic Stroke of Undetermined Source Patients in a Community Stroke Unit Setting

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
David Jones ◽  
Yael Perez ◽  
Hayley Wagman ◽  
Manu Mehdiratta
Keyword(s):  
Antithrombotic Therapy ◽  
Left Atrial ◽  
Stroke Unit ◽  
Anticoagulation Therapy ◽  
Embolic Stroke ◽  
Cardiac Monitoring ◽  
Stroke Recurrence ◽  
Stroke Work ◽  
Number Of Patients ◽  
The Impact

Recent post-hoc analyses of the NAVIGATE ESUS trial suggested a reduction in stroke recurrence with anticoagulation in a subset of embolic stroke of unknown source (ESUS) patients with left atrial enlargement (LAE>4.6 cm). In addition, the recent COMPASS trial demonstrated that anticoagulation using low-dose factor Xa inhibition reduces ischemic stroke in patients with clinically-apparent coronary artery (CAD) and peripheral artery disease (PAD). Currently, the rates of LAE, CAD and PAD among patients sent for prolonged cardiac monitoring and the impact of earlier screening in a community setting is unknown. We examined the prevalence of LAE and COMPASS eligibility in a prior stroke cohort who underwent prolonged cardiac monitoring (PROCAM) and identified gaps in antithrombotic therapy at the time of discharge. Patients admitted to the stroke unit with a suspected cardioembolic stroke/TIA and completed both 30-day cardiac monitoring and a transthoracic echocardiogram were offered participation in PROCAM within 30 days of stroke onset. A Spiderflash-T ECG or Northeast DR 200 monitoring device programmed for detecting AF was used. The primary outcomes were number of patients with ESUS, AF, LAE and COMPASS eligibility. Antithrombotic therapy at the time of discharge was also assessed. Among 296 patients referred for prolonged cardiac monitoring with a mean (SEM) age of 69 (0.8) and left atrial diameter of 3.6 cm (0.04), 131 patients (44%) were considered to have ESUS at the time of discharge. Among those ESUS patients, 10 patients (7.6%) had moderate to severe LAE (>4.6 cm), comparable rates to those observed in NAVIGATE ESUS. Additionally, 13 ESUS patients (9.9%) met COMPASS eligibility criteria and 16 (12.2%) were found to have AF following 30-day cardiac monitoring. 33 patients with ESUS (25.2%) were found to have either LAE, COMPASS criteria or AF following 30-day cardiac monitoring and were discharged on antiplatelet therapy. In conclusion, this research provides insight into the necessity of comprehensive stroke work-up for heterogeneous ESUS patients, with particular consideration to 30-day cardiac monitoring, LAE and COMPASS criteria, given that 25% of ESUS patients in our community-based cohort may benefit from anticoagulation therapy.

scholarly journals Evaluation of left atrial mechanics and p-wave dispersion as markers of left atrial cardiopathy in patients of embolic stroke of undetermined source (ESUS)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Masood ◽  
M.M Azharuddin ◽  
S.M.K Ashraf ◽  
S Wahab
Keyword(s):  
Left Atrial ◽  
Wave Dispersion ◽  
Embolic Stroke ◽  
P Wave ◽  
Electromechanical Delay ◽  
P Wave Dispersion ◽  
Atrial Electromechanical Delay ◽  
Wave Duration ◽  
P Wave Duration ◽  
Increased Risk

Abstract Introduction Around 25% of all ischaemic strokes have no known cause despite standard investigations. Most of these cases are suspected to have an embolic source for ischaemia, leading to the moniker of Embolic Stroke of Undetermined Source (ESUS). Recent studies suggest that abnormalities of the left atrium, in the form of atrial cardiopathy, can lead to increased risk of stroke even in the absence of atrial fibrillation (AF), which may be either as precursors to AF or as independent risk factors for the development of left atrial thrombus and subsequent stroke. Purpose The aim of this study was to measure LA electromechanical dissociation, LA volumes and P-wave dispersion as markers of atrial cardiopathy in patients with ESUS to determine whether atrial cardiopathy may be in the causal pathway of ESUS. Methods 28 patients presenting with ischaemic stroke and fulfilling the criteria for ESUS were enrolled into this cross-sectional, observational study. All patients had 24-hour Holter monitoring done to rule out the presence of AF. The control group consisted of 28 age- and gender-matched apparently healthy individuals. On ECG, P-wave Dispersion (PWD) was calculated by subtracting minimum P-wave duration from maximum P-wave duration. On echocardiography, time intervals from the beginning of P-wave to beginning of A' wave from the lateral mitral annulus in tissue doppler imaging was measured as the atrial electromechanical delay. LA volumes were recorded using the Modified Biplane Simpson's method. Statistical analysis was performed using student's t-test, chi-square test, and Pearson's test. Results Baseline demographic and laboratory characteristics were similar between the two groups. Increased PWD (34.14±9.89 ms vs. 27.32±8.95 ms; p=0.01), atrial electromechanical delay (73.32±16.31 ms vs. 63.63±13.59 ms; p=0.02) and LA volumes were observed in patients with ESUS as compared to controls. A significant correlation was also found between these parameters (p<0.01). Discussion According to the results of our study, PWD, atrial electromechanical delay and LA volumes may be novel predictors for ESUS. Atrial cardiopathy is a unique mechanism of thrombo-embolism in ESUS patients and our data establishes its association with ESUS. Further studies will be needed to shed more light on its role in the causality of stroke in the ESUS population. Measurement of electromechanical delay Funding Acknowledgement Type of funding source: None

Abstract WP232: Biomarkers of Atrial Cardiopathy and Atrial Fibrillation Detection on Mobile Continuous Outpatient Telemetry After Cryptogenic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Denise Sebasigari ◽  
Alexander Merkler ◽  
Guo Yang ◽  
Benjamin Kummer ◽  
Gino Gialdini ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Cryptogenic Stroke ◽  
Heart Rhythm ◽  
Population Based ◽  
Embolic Stroke ◽  
P Wave ◽  
Left Atrial Diameter ◽  
New Diagnosis ◽  
Rhythm Monitoring

Background: In population-based studies, biomarkers of atrial dysfunction or “cardiopathy” have been shown to be associated with embolic stroke risk. However, it is unclear if this risk is mediated by undiagnosed paroxysmal atrial fibrillation or flutter (AF). We aim to determine whether atrial cardiopathy biomarkers predict atrial fibrillation on continuous heart-rhythm monitoring after embolic stroke of undetermined source (ESUS). Methods: This was a single-center retrospective study including all patients who met consensus criteria for ESUS and who underwent 30 days of ambulatory heart-rhythm monitoring looking for AF between Jan 1 st , 2013 and Dec 31 st , 2015. We reviewed medical records for clinical, radiographic, and cardiac variables. The primary outcome was new diagnosis of AF detected during heart-rhythm monitoring. The primary predictors were atrial biomarkers: left atrial diameter on echocardiography, P-wave terminal force in ECG lead V1 , and PR interval on ECG. Multiple logistic regression was used to assess the relationship between atrial biomarkers and AF detection. Results: Among 196 eligible patients, 23 (11.7%) were diagnosed with AF. In unadjusted analyses, patients with AF were older (72.4 vs. 61.4 years, p < 0.001) and had larger left atrial diameter (39.2 vs. 35.7 mm, p = 0.03). In a multivariable model including variables significant on univariate analyses, the only predictor of AF was age ≥ 60 years (odds ratio, 3.0; 95% CI, 1.06-8.5; p = 0.04). Atrial biomarkers were not associated with AF detection. Conclusion: Atrial biomarkers were not associated with AF after ESUS. This suggests that previously reported associations between these markers and stroke may reflect independent cardiac pathways leading to stroke. Prospective studies are needed to investigate these mechanisms and study anticoagulation versus antiplatelet treatment for secondary stroke prevention in patients with ESUS and atrial cardiopathy.

P2463Advanced interatrial block is a surrogate for left atrial strain reduction which predicts atrial fibrillation and stroke

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Lacalzada Almeida ◽  
V Armarnani Armarnani ◽  
J Garcia-Niebla ◽  
M M Izquierdo-Gomez ◽  
R Elosua ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Left Atrial ◽  
Cox Regression ◽  
Imaging Techniques ◽  
P Wave ◽  
Control Group ◽  
End Point ◽  
Interatrial Block ◽  
New Onset

Abstract Background The association between advanced interatrial block (aIAB) and atrial fibrillation (AF) is known as “Bayes' Syndrome”. There is little information on the prognostic role that new speckle tracking echocardiographic (STE) imaging techniques could play in it. Purpose We have examined the relationship between left atrial (LA) STE and the prediction of new-onset AF and/or stroke in IAB patients. Methods Observational study with 98 outpatients: 55 (56.2%) controls with normal ECG, 21 (21.4%) with partial IAB (pIAB) and 22 (22.4%) with aIAB. The end-point was new-onset AF, ischemic stroke, and the composite of both. Results During a mean follow-up of 1.9 (1.7–2.3) years, 20 patients presented the end-point (18 new-onset AF and 2 strokes): 8 (14.5%) in the control group, 3 (14.3%) in pIAB and 9 (40.9%) in aIAB, p=0.03. In multivariable comprehensive Cox regression analyses, a decrease of strain rate during the booster pump function phase (SRa) was the only variable independently related to the appearance in the evolution of the end-point, in the first model (age, P wave duration and SRa): HR 19.9 (95% CI, 3.12–127.5), p=0.002 and in the second (age, presence of aIAB and SRa): HR 24.2 (95% CI, 3.15–185.4), p=0.002. Conclusions In patients with IAB, a decrease in absolute value of LA SRa with STE predicts new-onset AF and ischemic stroke. Acknowledgement/Funding None

Mutual Information as an Index of Diagnostic Test Performance

2003 ◽  
Vol 42 (03) ◽  
pp. 260-264 ◽  
Author(s):  
W. A. Benish
Keyword(s):  
Mutual Information ◽  
Diagnostic Test ◽  
Test Performance ◽  
Random Variable ◽  
Disease State ◽  
Necessary Condition ◽  
Conditional Probabilities ◽  
Amount Of Information ◽  
Diagnostic Test Performance ◽  
Test Result

Summary Objectives: This paper demonstrates that diagnostic test performance can be quantified as the average amount of information the test result (R) provides about the disease state (D). Methods: A fundamental concept of information theory, mutual information, is directly applicable to this problem. This statistic quantifies the amount of information that one random variable contains about another random variable. Prior to performing a diagnostic test, R and D are random variables. Hence, their mutual information, I(D;R), is the amount of information that R provides about D. Results: I(D;R) is a function of both 1) the pretest probabilities of the disease state and 2) the set of conditional probabilities relating each possible test result to each possible disease state. The area under the receiver operating characteristic curve (AUC) is a popular measure of diagnostic test performance which, in contrast to I(D;R), is independent of the pretest probabilities; it is a function of only the set of conditional probabilities. The AUC is not a measure of diagnostic information. Conclusions: Because I(D;R) is dependent upon pretest probabilities, knowledge of the setting in which a diagnostic test is employed is a necessary condition for quantifying the amount of information it provides. Advantages of I(D;R) over the AUC are that it can be calculated without invoking an arbitrary curve fitting routine, it is applicable to situations in which multiple diagnoses are under consideration, and it quantifies test performance in meaningful units (bits of information).

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