P1797 Left atrial mechanics in patients with stoke: Implications for emprical anticoagulation

Abstract Purpose Detection of atrial fibrillation (AF) after stroke impacts patient management. However, detection of AF is difficult due to its paroxsysmal nature. We sought to test the hypothesis that echocardiographic quantification left atrial (LA) mechanics in patients with stoke can be an imaging biomarker to predict AF. Methods We enrolled prospectively and consecutively 131 patients in normal sinus rhythm with a new diagnosis of ischemic stroke. All patients underwent 48-hour Holter monitorization, transthoracic echocardiography with saline injection in addition to routine work-up of stroke evaluation. Two-dimensional and Doppler studies, together with most up-to-date LA quantification tools were performed including 3-dimensional LA phasic volumes (maxiumum and minimum LA Volume index - LAVImax, LAVImin) and LA strain quantification (average strain from apical 4- and 2-chamber during reservoir (Ss) and contraction (Sa) phases). Patients were followed-up and underwent second 48-hour Holter monitorization 6-12 months later if no etiologic cause was found. Any AF episode lasting >30 seconds was considered significant parosysmal AF. Results In 49 patients, causes other than AF were identified (Noncryptogenic). In 43 patients no discernable cause was found (NoAF Cryptogenic). Paroxysmal AF episodes lasting longer than 30 sec were documented in 27 patients at first 48-hour Holter and in 12 patients during follow-up (9.2 ± 3.1 months) either by second 48-hour Holter monitorization or clinically (AF cryptogenic). LAVImax and LAVImin were significantly increased, Ss and Sa were significantly reduced in patients with AF as compared to No AF and Noncryptogenic groups (Table). LA volumes and strain measures predicted AF development independently of CHA2DS2-VASc score. Better discrimination between No AF and AF groups was obtained after second Holter monitorization that enabled detection of more cases with paroxysmal AF (Figure). Conclusions Our findings underscore the value of echocardiographic assessment of LA function as a marker of AF development and for selection of patients who could benefit from empiric anticoagulation. Noncryptogenic AF cryptogenic No AF cryptogenic 3D LAVI max (ml/m²) 30.1 ± 9,4 38.1 ± 12.7 28.9 ± 9.2 3D LAVI min (ml/m²) 13.9 ± 7.5 20.7 ± 10.7 13.4 ± 5.3 3D LA EF (%) 55.5 ± 9.4 50.0 ± 10.5 53.8 ± 10.0 Ss (%) 17.4 ± 8.5 12.7 ± 5.3 17.5 ± 8.5 Sa (%) 12.7 ± 6.3 9.0 ± 5.0 12.8 ± 6.3 CHA2DS2-VASc 4.0 ± 1.6 5.0 ± 1.6 3.9 ± 1.5 Abstract P1797 Figure.

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The characteristics of left atrial diverticula in normal sinüs rhythm patients

Surgical and Radiologic Anatomy ◽

10.1007/s00276-019-02382-w ◽

2019 ◽

Vol 42 (4) ◽

pp. 377-384

Author(s):

Mehmet Şeker

Keyword(s):

Sinus Rhythm ◽

Left Atrial ◽

Normal Sinus Rhythm ◽

Normal Sinus

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Can left atrial mechanics predict anticoagulation in cryptogenic stroke?

European Heart Journal ◽

10.1093/ehjci/ehaa946.2367 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Azul Freitas ◽

J Milner ◽

J Ferreira ◽

C Ferreira ◽

S Martinho ◽

...

Keyword(s):

Longitudinal Strain ◽

Normal Sinus Rhythm ◽

Cryptogenic Stroke ◽

Cardiac Monitoring ◽

Western World ◽

Normal Sinus ◽

Cardiac Evaluation ◽

Male Preponderance ◽

Left And Right ◽

Left Atrial Mechanics

Abstract Introduction Ischemic stroke is a leading cause of death and disability in the Western world, frequently due to cardioembolism and atherothromboembolism. Cryptogenic strokes occur without a well-defined aetiology after a standard vascular and cardiac evaluation, and secondary prevention may include antiplatelet therapy while awaiting results of long-term cardiac monitoring. In this study, we aimed to identify echocardiographic predictors of paroxysmal atrial fibrillation (AF) latter identified in follow-up of patients with cryptogenic stroke. Methods We retrospectively assessed all patients with cryptogenic stroke admitted in our hospital in the last 2 years. Only patients in normal sinus rhythm with a minimum of 24 hours of cardiac monitoring at admission and 24 hours Holter monitor within 6 months after discharge were included. Echocardiographic measures included left ventricle ejection fraction, left atrium (LA) volume, left and right atrium longitudinal strain, left and right ventricle longitudinal strain, E/A ratio, E/e' ratio, isovolumetric relaxation time (IVRT) and E wave deacceleration time. Echocardiographic data was assessed to determine its accuracy to identify AF. Results The study included 32 patients with a mean age of 72±10 years and a male preponderance (87.5%). AF was identified in 12 (37.5%) patients. This group of patients had a larger indexed LA volume (44.3 vs 29.1 mL/m2, p=0.043), a lower IVRT (87 vs 116 ms, p=0.028), and a lower LA longitudinal strain in contractile (6.7 vs 13.6%, p<0.001) and in reservoir phase (17.1 vs 23.6%, p=0.042). All other variables were not significantly different among groups, including LA longitudinal strain in conduit phase. LA longitudinal strain in contractile phase showed the best predictive power with an area under the ROC curve of 0.925 (95% CI 0.82–1 p=0.001). The cut-off value that best predicted AF was 8.17% with a sensitivity of 1 and specificity of 0.9. Conclusion LA longitudinal strain in contractile phase is a powerful method to identify AF in cryptogenic stroke. When reduced, anticoagulation may be considered in order to prevent recurrence. Further studies are warranted to reproduce these results in larger cohorts. Funding Acknowledgement Type of funding source: None

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Time Course of Left Atrial Mechanical Recovery After Linear Lesions: Normal Sinus Rhythm Versus a Chronic Atrial Fibrillation Dog Model

Journal of Cardiovascular Electrophysiology ◽

10.1046/j.1540-8167.2000.01397.x ◽

2000 ◽

Vol 11 (12) ◽

pp. 1397-1406 ◽

Cited By ~ 16

Author(s):

BOAZ AVITALL ◽

ARVYDAS URBONAS ◽

DALIA URBONIENE ◽

SCOTT MILLARD ◽

RAY HELMS

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Left Atrial ◽

Time Course ◽

Normal Sinus Rhythm ◽

Chronic Atrial Fibrillation ◽

Linear Lesions ◽

Normal Sinus ◽

Dog Model ◽

Mechanical Recovery

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Factors responsible for left atrial clot formation in patients with mitral stenosis and normal sinus rhythm

International Surgery Journal ◽

10.18203/2349-2902.isj20201011 ◽

2020 ◽

Vol 7 (4) ◽

pp. 1042

Author(s):

Pranay Suresh Mehsae ◽

Mohammad Abid Geelani ◽

Sayyad Ehtesham Hussain Naqui ◽

Soumyaranjan Das

Keyword(s):

Mitral Valve ◽

Sinus Rhythm ◽

Left Atrial ◽

Normal Sinus Rhythm ◽

Mitral Valve Stenosis ◽

Mitral Valve Area ◽

Normal Sinus ◽

Group A ◽

The Difference ◽

Valve Area

Background: The objective of the study was to investigate the factors responsible for left atrial (LA) clot formation in patients with mitral valve stenosis in normal sinus rhythm.Methods: 79 patients (43 males and 36 females) were included in the study. 9 patients with mitral stenosis in normal sinus rhythm had LA clot or LA smoke in echocardiography included in Group A and rest of 70 patients in Group B. LA size, gradient across mitral valve and mitral valve surface area was studied and compared in patients with or without LA clot/smoke.Results: Mean LA size was 4.8 (±0.5) and 4.6 (±0.7) in group A and B respectively with (p=0.304) and mean valve gradient was 11.6 (±2.8) and 10.6 (±3.5) in group A and B respectively with (p=0.507), the difference was not significant in both. Mean mitral valve area was 1.01 (±0.3) and 1.12 (±0.5) in group A and B (p=0.36), the difference was not significant.Conclusions: Study concluded that there was no significant difference in LA size, valve gradient and mitral valve area in patients with or without LA clot having mitral valve stenosis in normal sinus rhythm. Patients with LA clot warrant measures to prevent thromboembolic episodes.

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