Predictors of atrial fibrillation in patients with cryptogenic stroke and fifteen-days electrocardiographic monitoring. Preliminary results of the DECRYPTORING study

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Vera Sainz ◽  
A Cecconi ◽  
P Martinez Vives ◽  
A Ximenez Carrillo ◽  
C Aguirre ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Retrospective Studies ◽  
Cryptogenic Stroke ◽  
P Value ◽  
Ecg Monitoring ◽  
Funding Sources ◽  
Electrocardiographic Monitoring ◽  
3D Volume ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. onbehalf DECRYPTORING study Introduction Cryptogenic stroke (CS) represents up to 30% of all stroke types.  In one third of CS, atrial fibrillation (AF) is identified as the underlying cause. Predictors of AF in the setting of CS have been described, however these findings were based on retrospective studies and with maximum ECG monitoring of 72 hours. To overcome these limitations, we designed the prospective Decryptoring study whose objective is to create a comprehensive predictive model for AF in patients with CS. Methods From April 2019, 41 consecutive patients with a CS and age > 60 years were included. On admission, a transthoracic echocardiogram with 3D volume and left atrial (LA) strain was performed. All patients were monitored with a 15-day ECG-Holter after discharge. Patients were classified according to AF detection. Results AF was detected in 9 patients (22%). Patients with AF were older (75.9 ± 8 vs. 81.9 ± 4.3 years, p = 0.041). There was no difference in T-troponin levels. NTproBNP was higher in the group with AF (350 ± 586 pg / ml vs. 1084 ± 1416 pg / ml, p = 0.018). Regarding LA strain, patients with AF presented reservoir LA strain (25.5 ± 8.2% vs 17.4 ± 4.3%; p = 0.006) and conduct LA strain (12 ± 5.2% vs 7.2 ± 1.5%; p = 0.01) lower than patients without AF. There were no differences in contraction LA strain or other echocardiographic variables. The risk of developing AF was higher in patients with NTproBNP> 165 pg / ml (OR 11.3 [95% CI 1.2-102.9] p = 0.031), LA reservoir strain <19.1% (OR 7.7 [IC 95 % 1.5-40.0] p = 0.016) and LA conduct strain <9.1% (OR 7.8 [95% CI 1.3-45.0] p = 0.022) (Table). Conclusions This prospective study, demonstrates that high NTproBNP, low reservoir LA strain and low conduct LA strain are associated with underlying AF in patients with cryptogenic stroke. No AF (n = 32) AF (n = 9) P value Age (years) 75.9 ± 8 81.9 ± 4.3 p = 0.041 NTPROBNP (pg/ml) 350 ± 586 1084 ± 1416 P = 0.018 LA indexed diastolic volume (ml/m2) 30 ± 11.8 33.8 ± 9.8 P = 0.35 LA EF (%) 45 ± 16.7 45 ± 12.8 P = 1 Reservoir LA strain (%) 25.5± 8.2 17.4± 4.3 P = 0.006 Conduct LA strain (%) 12 ± 5.2 7.2 ± 1.5 P = 0.01 Contraction LA strain (%) 13.5 ±5.3 10.2± 3.9 P = 0.10 NTPROBNP > 165 pg/ml 12 (41%) 8 (89%) OR 11.3 [IC 95% 1.2-102.9]; p = 0.031 Reservoir LA strain <19.1% 6 (20%) 6 (67%) OR 7.7 [IC 95% 1.5-40.0]; p = 0.016 Conduct LA strain <9.1% 9 (31%) 7 (78%) OR 7.8 [IC 95% 1.3-45.1]; p = 0.022

scholarly journals Left atrial function after successful catheter ablation for paroxysmal atrial fibrillation: cryoablation versus radiofrequency techniques

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
E Pilichowska ◽  
A Sikorska ◽  
J Baran ◽  
R Piotrowski ◽  
T Krynski ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Paroxysmal Atrial Fibrillation ◽  
Left Atrial ◽  
Speckle Tracking ◽  
The Body ◽  
P Value ◽  
Rf Ablation ◽  
Funding Sources ◽  
Baseline Values ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Purpose It has been suggested that cryoballoon (CB) ablation for paroxysmal atrial fibrillation (PAF) may lead to more extensive left atrial (LA) injury than radiofrequency (RF) ablation, however, results are conflicting. We sought to address this issue using modern echocardiographic techniques. Methods We performed transthoracic echocardiography in 90 patients (66% males, mean age 57 ± 10 years) successfully treated  with RF (51%) or CB (49%) ablation for PAF before and 6 months after the procedure. Peak longitudinal LA strain (LAS) and strain rate (LASR) during the reservoir (r), conduit (cd) and contraction (ct) phases were measured during sinus rhythm by speckle tracking. The LA diameter and volume (LAV) index - using biplane area-length method divided by the body surface area were also calculated. Results The LA diameter decreased (38.1 ± 4.0 vs 37.2 ± 3.8 mm, p = 0.004), the LAV index did not change (33.5 ± 11.9 vs 34.4 ± 8.9 mL/m², p = 0.272) at 6 months in the whole study group. The LASRr and LASRcd increased, whereas there were no changes in remaining LA function parameters in either ablation strategy (table). The CB subgroup did not differ in LA function parameters comparing to RF subgroup at six months after procedure (table). Conclusion CB and RF ablation did not differentially affect the LA function. Successful ablation for PAF resulted in improvement of  rate of deformation during reservoir and conduit LA cycle and stable contractile LA function. LA function parameters RF N = 46 (51%) CB N = 44 (49%) 6 months RF vs CB Parameter Baseline 6 months p Baseline 6 months p p* Global LASr [%] 27.7 ± 6.35 27.9 ± 6.0 0.833 27.9 ± 7.2 27.0 ± 6.4 0.370 0.539 Global LAScd [%] -14.6 ± 4.1 -14.8 ± 4.6 0.761 -15.3 ± 5.3 -14.1 ± 3.2 0.080 0.399 Global LASct [%] -13.0 ± 4.84 -13.0 ± 3.20 1.00 -12.6 ± 3.81 -12.9 ± 4.18 0.629 0.897 Global LASRr [sˉ¹] 1.18 ± 0.22 1.27 ± 0.26 0.046 1.07 ± 0.27 1.18 ± 0.30 0.041 0.141 Global LASRcd [sˉ¹] -1.11 ± 0.33 -1.25 ± 0.35 0.013 -1.07 ± 0.31 -1.16 ± 0.30 0.044 0.214 Global LASRct [sˉ¹] -1.46 ± 0.40 -1.50 ± 0.31 0.500 -1.42 ± 0.51 -1.39 ± 0.42 0.742 0.187 *p value corrected for baseline values

Prevalence of paroxysmal atrial fibrillation in patients with cerebrovascular stroke of undetermined etiology

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammed Elnwagy ◽  
Hossam Shokery ◽  
Emad Effat ◽  
Hayam El Damnhory
Keyword(s):  
Atrial Fibrillation ◽  
Paroxysmal Atrial Fibrillation ◽  
Left Atrial ◽  
Cryptogenic Stroke ◽  
Holter Monitoring ◽  
Ectopic Beat ◽  
Unknown Etiology ◽  
P Value ◽  
Undetermined Etiology ◽  
Cerebrovascular Stroke

Abstract Background cerebrovascular stroke is major cause of morbidity and disability. Many causes may contribute to its presence, however. Some patients have none of the identified risk factors, yet face the consequences of stroke or transit ischemic attack. This type of stroke known to be stroke of undetermined source or etiology. It has a high rate of recurrence due to the persistence of the unknown etiology. Paroxysmal atrial fibrillation remains the hidden bottom of an iceberg representing a major part of the causes of ischemic cerebrovascular stroke of undetermined etiology . Aim and Objectives: to determine the prevalence of subclinical atrial fibrillation in patients with ischemic cerebrovascular stroke of undetermined etiology in a population in Egypt by 48h holter monitoring. Patients and Methods Patients diagnosed with acute cerebrovascular stroke of undetermined etiology at the neurology department of Ain Shams university hospitals underwent 48 hours holter monitoring within the first week of the insulting event. Results This study included 50 patients with cryptogenic stroke (CS) who underwent 48 hours holter monitoring. The patients' ages ranged between 22 and 77 years old (mean age 48.46 ± 12.74years). This study included 34 males and 16 females. Their body mass index BMI ranges from 21-35 kg/m2, with mean BMI of 24.78 ± 2.99 kg/m2. Their left atrial diameter ranges from 26-47mm, with mean diameter of 36.08 ± 5.23mm .Eight out of fifty patients newly diagnosed with subclinical atrial fibrillation with prevalence of 16%. There was statistically significant association between the atrial fibrillation (AF) and both age (p value, 009) and left atrial (LA) diameter (p value, 001) .There was an associated finding that need further investigation about the significant association between the ventricular ectopic beat VEB burden and the presence of AF or stroke. Conclusion The prevalence of paroxysmal atrial fibrillation among the population of ischemic stroke of undetermined etiology in a population in Egypt is close to worldwide percentage and the recent met analysis studies of 11%.

P3383Left atrial appendage and left atrial morphology is associated with cryptogenic stroke

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Adukauskaite ◽  
F Barbieri ◽  
T Senoner ◽  
F Plank ◽  
M Knoflach ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Left Atrial ◽  
Multivariable Analysis ◽  
Cryptogenic Stroke ◽  
Patient Characteristics ◽  
Atrial Appendage ◽  
P Value ◽  
Clinical Patient

Abstract Background Stroke causes a high burden of morbidity and mortality worldwide. Approximately 30% of stroke cases remain cryptogenic (CS), of which one third is due to occult atrial fibrillation (AF) with left atrial appendage (LAA) being the most frequent thrombus source. Hence, aim of our study was to assess if LAA morphological parameters analysed by computed tomography angiography (CTA) are associated with CS. Methods and materials In 184 patients (Table 1), 82 CS patients and 102 controls (age median 62 (52,2–72), 40.2% females), matched for BMI, a CTA was performed, and LAA morphology evaluated retrospectively. LAA morphology was classified into 5 types (Figure 1): Cactus, Cauliflower, Chicken-wing, Windsock and the new “Seahorse” with a distinctive tip angulation of ≤90° and 2 bends (Z-shape). Further measurements included: LAA tip angulation (≤90°, 91–110°, >110°), LAA lobe number, LAA ostium size (length) and angulation, left atrium wall thickness (LAWT). Results LAA and left atrium (LA) parameters associated with CS on multivariable analysis after adjusting for CHA2DS2-VASc score were: Chicken-wing type (OR 2.15; 95% CI: 1.01–4.56, p=0.046), a greater lobe number (OR 2.01; 95% CI: 1.52–2.64, p<0.001), a greater middle and mean LAWT (respectively, OR 2.13; 95% CI: 1.49–3.05, p<0.001, OR 2.64; 95% CI: 1.63–4.29, p<0.001), a larger (length, OR 1.08; 95% CI: 1.0–1.16, p=0.039) and a less bent LAA ostium (OR 1.02; 95% CI: 1.01–1.03, p=0.006). In contrast, a sharp-angled LAA tip (≤90°) was protective from CS (OR 0.43; 95% CI: 0.23–0.83, p=0.012) on multivariable analysis. Table1. Clinical patient characteristics CS (n=82) Non-stroke (n=102) p value Females 21 (25.6%) 53 (52%) p<0.001 Age, y 66.5 (57–73) 57.5 (50–70) 0.001 BMI, kg/m2 25.6 (23.9–28.2) 26 (23.3–30.1) 0.320 CHA2DS2-VASc score 2 (1–3) 2 (1–3) 0.387 AF (paroxysmal/permanent) 0 4 0.071 Hypertension 68 (82.9%) 54 (56.3%) p<0.001 Diabetes mellitus, type 2 16 (19.8%) 11 (11.5%) 0.145 Values are given in median ± IQR. AF, atrial fibrillation; BMI, body mass index. LAA and LA morphology in CTA. Conclusion In CS, a Chicken-wing LAA, a greater number of lobes and a thicker LA wall are independently associated with CS while a sharp LAA tip (≤90°) mostly seen in Seahorse type LAA is protective. Such “high-risk” LAA and LA morphology could help to select CS patients benefiting from extended rhythm-monitoring to detect an occult AF, however, further prospective studies are needed to confirm this hypothesis.

scholarly journals Use of speckle-tracking echocardiography to stratify risk of atrial fibrillation-related stroke: comparison of left atrial and atrial appendage mechanics

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
Y Mao ◽  
Y Yang ◽  
C Yu ◽  
MM Ma ◽  
YH Wang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Speckle Tracking ◽  
Univariate Analysis ◽  
Diagnostic Value ◽  
P Value ◽  
Analysis Model ◽  
Time To Peak ◽  
Funding Sources ◽  
Increased Risk

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): the National Natural Science Foundation of China onbehalf Sir Run Run Shaw Hospital,Zhejiang University,School of Medicine Background Left atrial (LA) and appendage (LAA) dysfunction were associated with increased risk of stroke in atrial fibrillation. However, usefulness of LA and LAA mechanics has not been fully compared. Methods:201 AF patients were prospectively enrolled. 42(20.8%) had previous stroke/TIA.  Speckle tracking was used to measure LA and LAA peak postive strain. LA and LAA MD was defined as the SD of time to peak positive strain corrected by the R-R interval. Results:LA MD and LAA MD were independently associated with stroke/TIA. The model based on CHA2DS2-VASc score for discrimination of stroke was significantly improved by adding LA MD or LAA MD (P &lt; 0.01). Diagnostic value of LA MD was better than LAA MD in patients with normal LA volumes, while LAA MD was more useful in patients with LA enlargement.Conclusion:Both LA and LAA mechanics had incremental value over CHA2DS2VASc score. However, priorities of strain assessment depend on patients’ LA volume. Variables Univariate analysis Multivariate analysis Model 1 Model 2 Model 3 OR (95% CI) P value OR (95% CI) P value OR (95% CI) p value OR (95% CI) P value Clinical parameters Age 1.09(1.04-1.14) &lt;0.001 1.11(1.04-1.17) 0.001 1.11(1.05-1.17) 0.001 1.11(1.04-1.17) 0.001 BMI 0.988(0.89-1.10) 0.84 1.07(0.92-1.25) 0.40 1.07(0.91-1.25) 0.40 CHA2DS2-VASc score 1.52(1.15-2.00) 0.003 1.08(0.67-1.74) 0.76 1.08(0.65-1.80) 0.77 1.10(0.69-1.76) 0.69 Persistent AF 1.88(0.94-3.74) 0.07 0.75(0.23-2.40) 0.63 0.87(0.27-2.81) 0.82 Therapeutic anticoagulation 0.56(0.28-1.11) 0.10 0.22(0.09-0.57) 0.002 0.23(0.09-0.59) 0.002 0.22(0.09-0.57) 0.002 LA parameters LAEF 0.96(0.94-0.99) 0.002 0.982(0.953-1.01) 0.26 iLAVmin 1.03(1.01-1.05) 0.006 0.98(0.94-1.02) 0.27 LA MD 1.22(1.10-1.36) &lt;0.001 1.16(1.02-1.32) 0.02 1.18(1.03-1.34) 0.02 1.16(1.02-1.32) 0.02 LA GLS 0.935(0.893-0.98) 0.005 1.0(0.953-1.14) 0.36 1.02(0.94-1.12) 0.59 1.02(0.94-1.10) 0.72 LAA parameters LAAEV 0.12(0.02-0.74) 0.02 3.34(0.31-36.06) 0.32 LAA EF 0.98(0.96-1.00) 0.06 1.01(0.98-1.04) 0.65 LAA GLS 0.85(0.77-0.94) 0.001 0.96(0.86-1.07) 0.46 0.97(0.87-1.08) 0.59 0.96(0.87-1.06) 0.44 LAA dense SEC/thrombus 3.12(1.39-6.99) 0.006 2.02(0.75-5.45) 0.167 LAA MD 1.19(1.09-1.29) &lt;0.001 1.19(1.08-1.31) 0.001 1.19(1.08-1.31) 0.001 1.19(1.08-1.31) 0.001 Univariable and multivariable logistic regression analyses of associations between clinical and echocardiographic covariates with stroke Abstract Figure.

scholarly journals 606 Predictive value of left atrial and left ventricular strain for the detection of atrial fibrillation in patients with cryptogenic stroke

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Gabriella Bufano ◽  
Francesco Radico ◽  
Carolina Maria D’Angelo ◽  
Francesca Pierfelice ◽  
Maria Vittoria De Angelis ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Predictive Value ◽  
Left Atrial ◽  
Longitudinal Strain ◽  
Cryptogenic Stroke ◽  
Left Ventricular ◽  
Volume Index ◽  
Lv Function ◽  
Ecg Monitoring ◽  
Echocardiographic Parameters

Abstract Aims Cryptogenic stroke (CS) is associated with high rate of recurrences and adverse outcomes at long-term follow-up, especially in light of its unknown etiology that often leads to ineffective secondary prevention. In such scenario, asymptomatic misdiagnosed atrial fibrillation (AF) episodes could play an important pathophysiological role. Some studies have pointed left atrial (LA) and left ventricular (LV) systolic and diastolic dysfunction as surrogate markers of AF. The aim of this study was to evaluate the relationship between echocardiographic parameters of LA and LV function, and the occurrence of AF revealed by continuous electrocardiogram (ECG) monitoring in a cohort of CS patients. Methods and results This is a single-centre prospective cohort study. Seventy-two CS patients with continuous ECG monitoring with insertable cardiac monitor (ICM) underwent transthoracic echocardiography (TTE). TTE was focused on LA and LV function, including both standard and longitudinal strain-derived parameters. All detected AF episodes lasting more than 2 min were considered. Patients with and without AF were homogeneous in all baseline characteristics, except for CHA2DS2-VASc score, which was significantly higher in AF group, and prevalence of hypercholesterolaemia, that was significantly higher in no-AF group. ICM revealed AF in 23 patients (32%), on average 196 days after ICM implantation. Among echocardiographic parameters, LV ejection fraction (LVEF, P = 0.007), LA end systolic area (LAES area, P = 0.006), LA volume index (LAVI, P = 0.008), total LA emptying fraction (LATEF, P = 0.013), E velocity (P = 0.042), pulmonary veins AR duration (P = 0.01), septal and median TDI E/e′ (respectively, P = 0.045 and P = 0.039), peak atrial longitudinal strain (PALS) in 4-chamber and in 2-chamber view (respectively, P &lt; 0.001 and P = 0.011), peak atrial contraction strain (PACS, P &lt; 0.001), LA conduit strain (P = 0.005), and LV longitudinal strain (LVLS, P = 0.001) were significantly associated to the occurrence of AF, suggesting worst atrial function in AF group. Furthermore, multivariable regression analysis revealed that PACS and LV strain were the only echocardiographic parameters independently associated with AF [confidence interval (CI) 95%: 0.48–0.90, P = 0.005 and CI 95%: 0.46–0.95, P = 0.041 respectively]. Conclusions In a cohort of CS patients, continuous ECG monitoring with ICM revealed subclinical AF episodes in about one-third of patients. In such population, LA and LV strain analysis add predictive value for occurrence of AF over clinical and morpho-functional echocardiographic parameters. Impaired booster pump strain and LVLS strain are strong and independent predictors of AF.

Abstract 15866: The Utility of Extended Electrocardiographic Monitoring for Detecting Atrial Fibrillation in Cryptogenic Stroke in the African-american Population

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Romy Rodriguez Ortega ◽  
Mohammed AlSadawi ◽  
Violeta Capric ◽  
Baho Sidiqi ◽  
Jonathan Francois ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
African American ◽  
Univariate Analysis ◽  
Cryptogenic Stroke ◽  
Disease Diagnosis ◽  
Channel Blockers ◽  
Ecg Monitoring ◽  
Loop Recorder ◽  
Electrocardiographic Monitoring ◽  
Baseline Characteristics

Introduction: Cryptogenic stroke comprises about 25% of all ischemic strokes. Depending on modality and duration of ECG monitoring, subclinical atrial fibrillation (AF) is detectable in 2.7-30% of cryptogenic stroke patients. Hypothesis: Extended ECG monitoring has not been studied in the African American (AA) population. This retrospective study aims to study the incidence and risk factors of subclinical AF in African-Americans. Methods: We retrospectively reviewed 96 patients who received implantable loop recorders (ILR) for detecting subclinical atrial fibrillation after cryptogenic stroke. In the vast majority of patients, the ILR was implanted during the index hospitalization. Binary univariate and multivariate analyses were performed to determine predictors for AF detection. Results: AF was detected in 29% of patients (28/96) at 1000 days. All AF that was detected was exquisitely paroxysmal and ranged in duration between 0.05-103 minutes (mean 8.4 minutes with SD= 22.1 minutes). Baseline characteristics of patients are presented (Table 1A). Binary univariate analysis revealed the use of non-dihydropyridine calcium-channel blockers to be associated with decreased odds of AF detection. (Table 1B, C). Multivariate analysis found coronary artery disease diagnosis to be associated with increased odds of AF detection. Fifty-percent of the events in the AF group were detected within the first 36 days of loop recorder implantation (Fig 1). Conclusions: AF detection in our population occurs very early after index stroke and at significantly higher rates than reported in the CRYSTAL AF trial. Baseline characteristics have a poor predictive ability for the detection of AF. These findings emphasize the need for pre-discharge ILR implantation to improve AF detection in all patients with cryptogenic stroke.

Abstract WMP64: Utility of Left Atrial Abnormality on Admission Electrocardiography in Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Yukio Sugiyama ◽  
Nobuyuki Ohara ◽  
Kotaro Watanabe ◽  
Junya Kobayashi ◽  
Daisuke Takahashi
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Left Atrial ◽  
Strong Predictor ◽  
Multiple Logistic Regression Analysis ◽  
Cryptogenic Stroke ◽  
P Wave ◽  
Cardioembolic Stroke ◽  
Ecg Monitoring

Introduction and Hypothesis: Clinical categorization of ischemic stroke is very important to select the antithrombotic therapy for preventing the recurrent stokes. However, about 25% of ischemic stroke is the stroke for undetermined cause, termed as cryptogenic stroke. Recently, proactive detecting of paroxysmal atrial fibrillation (PAF) in cryptogenic stroke has gained attention. P-wave terminal force in lead V1 (PTFV1) of electrocardiography (ECG) is a specific indicator of left atrial abnormality. In this study, we tested PTFV1 for the utility of PAF detection and further clinical categorization in acute ischemic stroke. Methods: One hundred forty eight consecutive acute ischemic stroke patients were admitted to our hospital from September 2014 to March 2016. We included 105 patients (mean age 72.8±13.4 years), who had sinus rhythm on admission 12-lead ECG without atrial fibrillation, or cardiac pacing. PTFV1 (mmхsec) of participants was assessed, and had analyzed the association with PAF detection in a 24-hour ECG monitoring and clinical categories of ischemic stroke. Results: PTFV1 was significantly higher in the patients with PAF (n=11) than in those without PAF (0.049±0.024 vs 0.031±0.027; p<0.05). Multiple logistic regression analysis revealed that PTFV1 was an independent predictor for PAF detection (odds ratio, 1.46; 95% confidence interval, 1.02-2.08; p<0.05). According to the clinical categorization, PTFV1 of cardioembolic stroke (0.061±0.022) was significantly higher, compared to lacunar stroke (0.018±0.019; p<0.01), atherothrombotic stroke (0.035±0.026; p<0.05), and cryptogenic stroke (0.031±0.029; p<0.05). The proportion of patients with left atrial abnormality defined by PTFV1 (≧0.04), was 10 out of 11 (91%) for cardioembolic stroke, and 10 out of 27 (37%) for cryptogenic stroke. Conclusions: PTFV1 on admission ECG in acute ischemic stroke was a strong predictor for PAF detection and cardioembolic stroke diagnosis. Extended ECG monitoring may be useful in cryptogenic stroke with left atrial abnormality defined by PTFV1.

scholarly journals P318 Left atrial dysfunction assessed by echocardiography in relation to left atrial fibrosis in patients undergoing ablation for atrial fibrillation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
E Pilichowska ◽  
J Baran ◽  
P Kulakowski ◽  
B Zaborska
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Systolic Function ◽  
Electrophysiological Study ◽  
Stiffness Index ◽  
P Value ◽  
Group 2 ◽  
Left Atrial Dysfunction ◽  
Left Atrial Fibrosis ◽  
Group 1

Abstract PURPOSE Left atrial (LA) fibrosis is the hallmark of LA remodeling in atrial fibrillation (AF), alters LA function and may predict poor catheter ablation (CA) outcome. LA fibrosis may be assessed invasively using electroanatomical mapping (EAM) during electrophysiological study. The aim was to assess LA function parameters in relation to degree of LA fibrosis derived from EAM in patients with AF. METHODS Patients (pts) n = 39 (79% males, mean age 56+/-10) with non-valvular AF were studied with TTE and TEE before first CA during sinus rhythm. LA strain (LAS) and strain rate (LASR) were analyzed in reservoir (r), conduit (cd) and contractile (ct) phases. The velocities of mitral A, E" and A" were measured with Doppler. E/E" and LA stiffness index - the ratio of E/E" to LASr were assessed. LA appendage flow velocity (LAAv) was measured in TEE. LA volume using biplane area-length method was calculated. The EAM of LA was build using Carto System before CA. Low amplitude potentials area (LAPA) was quantitatively analyzed and expressed as a percentage of LA surface using the cut-off &lt;0.5 mV to detect sites of fibrosis. LA parameters were compared between mild (LAPA &lt;10%) moderate (LAPA 10-40%) and extensive degree of LA fibrosis (LAPA &gt;40%) (table). RESULTS The mean LA volume was 35 ± 11 mL/m². The LAPA ranged from 2 to 78 % of LA surface. Reduced LA function was observed in the LAPA &gt;40% group. Extensive LAPA altered mainly LA compliance parameters. Traditional LA systolic function parameters did not differ in relation to degree of LAPA. CONCLUSION LA compliance is mostly affected by LA fibrosis, thus LA diastolic parameters may be useful in the noninvasive assessment of LA fibrosis. Whether these parameters should be a part of the proper selection of candidates for CA requires further studies. LA function parameters LA parameters Group 1 LAPA &lt;10% n = 13 Group 2 LAPA &gt;10% &lt;40% n = 13 Group 3 LAPA &gt;40% n = 13 P-value Group 1 + 2 vs 3 Mitral A 0.55 ± 0.10 0.55 ± 0.24 0.73 ± 0.32 0.077 A" 9.19 ± 1.74 7.85 ± 1.43 7.92 ± 2.40 0.376 LASr 31.48 ± 4.52 26.48 ± 8.79 19.63 ± 6.76 &lt;0.001 LAScd 17.30 ± 3.05 15.44 ± 6.93 10.91 ± 4.04 0.003 LASct 14.18 ± 5.36 11.05 ± 3.67 8.72 ± 4.78 0.024 LASRr 1.22 ± 0.19 1.24 ± 0.21 0.92 ± 0.20 &lt;0.001 LASRct -1.71 ± 0.46 -1.37 ± 0.34 -1.04 ± 0.33 &lt;0.001 LA stiffness 0.20 ± 0.07 0.34 ± 0.17 0.63 ± 0.29 &lt;0.001 LAAv 0.83 ± 0.18 0.55 ± 0.17 0.60 ± 0.16 0.178

scholarly journals Potential Biological Markers of Atrial Fibrillation: A Chance to Prevent Cryptogenic Stroke

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
István Szegedi ◽  
László Szapáry ◽  
Péter Csécsei ◽  
Zoltán Csanádi ◽  
László Csiba
Keyword(s):  
Atrial Fibrillation ◽  
Biological Markers ◽  
Cryptogenic Stroke ◽  
Biological Marker ◽  
Ecg Monitoring ◽  
Inflammation Markers ◽  
Good Patient ◽  
Markers Of Inflammation ◽  
Good Patient Compliance ◽  
And Function

Stroke affects millions of people all over the world, causing death and disability. The most frequent type of this disease is ischemic stroke, which can be caused by different factors. In approximately 25 percent of cases, no obvious cause can be found. Recent observations have shown that paroxysmal atrial fibrillation could be responsible for a significant number of cryptogenic stroke events. Short- or long-lasting ECG monitoring could help with the diagnosis of transient arrhythmias. Unfortunately, these techniques either are expensive or require good patient compliance. An alternative option is the identification of biological markers that are specific for atrial fibrillation and can be used to predict arrhythmia. In this review, we give a summary of the recent advances in the research of arrhythmia markers. Based on their structure and function, we differentiated four groups of biomarkers: markers of inflammation, markers of fibrosis, markers with hormonal activity, and other markers. In spite of intensive researches, the optimal biological marker is still not available, but there are some promising markers, like NT-proBNP/BNP.

Abstract P709: Risk Factors Associated With Atrial Fibrillation Detection by Mobile Cardiac Outpatient Telemetry Following Acute Ischemic Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Ovais Inamullah ◽  
Alec McConnell ◽  
Hussein Al-khalidi ◽  
Gerald S Bloomfield ◽  
Shreyansh Shah
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Patient Selection ◽  
Left Atrial ◽  
Cryptogenic Stroke ◽  
Left Ventricular ◽  
Stepwise Logistic Regression ◽  
Internal Diameter ◽  
Atrial Area

Background: Mobile Cardiac outpatient telemetry (MCOT) is often used for patients (pts) with cryptogenic ischemic stroke following hospital discharge to detect atrial fibrillation (AFib) but criteria for patient selection remains a subject of debate. Methods: We identified 297 pts hospitalized with acute ischemic stroke who had an inpatient transthoracic echocardiogram (TTE) and underwent MCOT upon discharge between 2016 and 2018 at a large academic comprehensive stroke center. Pts characteristics between AFib vs. no AFib were compared by Fisher’s exact test for categorical and Wilcoxon rank-sum test for continuous variables. A multivariable stepwise logistic regression model was developed to determine the predictors of AFib detection. Statistical hypotheses were tested as two-sided at 0.05 level of significance. Results: Of the 297 pts, AFib was detected in 24 (8.1%) on 30-day MCOT. Pts with AFib detected were older, white, and have had a larger left atrial area (Table). The final logistic model demonstrated that white race (vs. non-white) (OR 4.86, 1.53-15.41), left atrial area (OR 1.15, 1.05-1.25) and left ventricular internal diameter in diastole (OR 0.33, 0.16-0.67) were associated with AFib detection by MCOT. Conclusion: Although rates of AFib detection on 30-day MCOT post-discharge was low, there are important patient characteristics and TTE features that can improve patient selection. Further studies are needed to determine if this data can be used prospectively to clinically decide which pts with cryptogenic stroke should be given 30-day MCT to detect atrial fibrillation.

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