Transoesophageal echocardiography in patients with acute stroke with sinus rhythm and no cardiac disease history

Background: Soluble ST2 (sST2) is a decoy receptor that modulates the anti-hypertrophic and anti-fibrotic IL-33/ST2 pathway. sST2 is associated with adverse prognosis in HF and ACS; both states are associated with cardiac injury. However, sST2 levels are also increased in non-cardiac disease. To determine the extent of cardiac production of sST2 both chronically and after acute myocardial injury, we measured fractional cardiac production of sST2 compared to the cardiac specific injury marker high sensitive (hs) cTnT before and after elective cardiac ablation. Methods: Twenty-three patients undergoing ablation of atrial fibrillation were enrolled [Caucasian 22 (96%); Male 17 (74%); Age 57.7±10.4 years; eGFR 58.7 ± 0.6 mL/min/1.73m2). Of the 23, 15 (65%) had paroxysmal atrial fibrillation. At baseline, 14 (61%) were in sinus rhythm. Samples were obtained from the radial artery and coronary sinus (CS) pre- and post-ablation. sST2 was measured by the Presage assay. Post ablation samples were measured 201±44 minutes after the first ablation. Results: At baseline, in contrast to cTnT, there was no cardiac production of sST2. Both arterial and CS levels of sST2 increased after ablation but not nearly to the extent of cTnT. No net cardiac production of sST2 was noted (Table). Conclusion: Cardiac production of sST2 is not observed at baseline. Systemic sST2 levels modestly increase following acute myocardial injury. Despite direct myocardial injury, no cardiac production of sST2 is observed. The source of sST2 is extra-cardiac both chronically and after acute injury.

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Relationship between Lambl’s excrescences and embolic strokes of undetermined source

European Stroke Journal ◽

10.1177/2396987319901201 ◽

2020 ◽

Vol 5 (2) ◽

pp. 169-173

Author(s):

Setareh Salehi Omran ◽

Salama Chaker ◽

Mackenzie P Lerario ◽

Alexander E Merkler ◽

Babak B Navi ◽

...

Keyword(s):

Acute Stroke ◽

Case Control Study ◽

Transoesophageal Echocardiography ◽

Embolic Stroke ◽

Large Vessel ◽

Large Artery ◽

Multiple Logistic Regression ◽

Stroke Treatment ◽

The Relationship ◽

Control Study

Introduction About one-fourth of ischaemic strokes are classified as embolic strokes of undetermined source. Lambl’s excrescences are commonly seen on cardiac valves, and data are limited on whether they may be a source of embolization. We examined the relationship between Lambl’s excrescences and embolic stroke of undetermined source. Patients and Methods We performed a case-control study of patients in the Cornell AcutE Stroke Academic Registry. Stroke aetiologies were adjudicated using the Trial of Org 10172 in Acute Stroke Treatment and embolic stroke of undetermined source criteria. We included patients with acute ischaemic stroke between 2011 and 2016 who underwent transthoracic or transoesophageal echocardiography within six months of hospitalisation. Cases were embolic stroke of undetermined source patients and controls were patients with an identified, non-cardioembolic stroke aetiology (i.e. small- or large-vessel strokes). Multiple logistic regression was used to evaluate the association between Lambl’s excrescences and embolic stroke of undetermined source after adjustment for demographics, comorbidities and mode of echocardiography. Results A total of 923 patients met the criteria for this analysis, including 530 with embolic stroke of undetermined source and 393 with small- or large-vessel strokes. Lambl’s excrescences were identified in 47 (8.9%) patients with embolic stroke of undetermined source and 11 (2.8%) patients with small- or large-artery strokes, but the majority (54/58) of Lambl’s excrescences were visualised on transoesophageal echocardiogram and embolic stroke of undetermined source patients were more likely to undergo transoesophageal echocardiogram. After adjustment for demographics, comorbidities and mode of echocardiography, we found no association between the presence of Lambl’s excrescences and embolic stroke of undetermined source (odds ratio 0.9; 95% confidence interval 0.4–2.3). Conclusion We found no association between Lambl’s excrescences and embolic stroke of undetermined source. These results do not support the hypothesis that Lambl’s excrescences are an occult cause of embolic stroke of undetermined source.

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499 Transoesophageal echocardiography guided cardioversion of atrial fibrillation: safety profile and impact on sinus rhythm maintenance at 1 year

European Journal of Echocardiography ◽

10.1016/s1525-2167(05)80248-3 ◽

2005 ◽

Vol 6 ◽

pp. S66-S66

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Safety Profile ◽

Transoesophageal Echocardiography ◽

Sinus Rhythm Maintenance

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Outcome and clinical profile of patients with newly detected atrial fibrillation and cardioembolic stroke

European Heart Journal ◽

10.1093/eurheartj/ehab724.2058 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

S Garkina ◽

R Tatarskiy ◽

D Lebedev ◽

O Efimova ◽

T Pavlova ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Acute Stroke ◽

Hazard Ratio ◽

Clinical Profile ◽

Cardioembolic Stroke ◽

Smoking History ◽

Adjusted Risk ◽

Increased Risk

Abstract Background Atrial fibrillation (AF) is a global health care problem with evidence suggesting an increasing prevalence and incidence worldwide. Undiagnosed AF represents the most common cause of thromboembolic events. The aim of the study was to analyze the clinical profile and outcome in patients with cardioembolic stroke and newly detected AF. Methods We enrolled 139 consecutive patients with atrial fibrillation and confirmed diagnosis of ischemic stroke (mean age 72.25±6.33 years, 59 male). Follow-up period was 1 year since the episode of acute stroke. Results All patients with verified cardioembolic stroke were first diagnosed with AF on admission. Patients with AF were characterized by polymorbidity (hypertension was diagnosed in 96 patients, a concomitant chronic renal failure was observed in 60 cases while a complicated course of coronary heart disease – in 35 patients, 22 patients were diagnosed with diabetes mellitus, while 9 people had a long smoking history). Mean value of CHA2DS2-VASc score was 4.51±1.2 and after acute stroke patients were recommended permanent anticoaugulation (12% – warfarin, 45% – rivaroxaban, 24% – apixaban and 19% – dabigatran). At the end of the year of follow-up patients were taking oral anticoagulants only in 16.2% of cases. In the same time only 9.9% of patients had a history of mild or moderate nasal or gingival bleeding (8.2%) while severe hemorrages were not reported. On multivariable analysis, lack of antithrombotic treatment guideline adherence was associated with increased risk of recurrent stroke (hazard ratio, 4.45; 95% confidence interval, 1.25–6.87; P=0.012 for undertreatment). For 3 (2.2%) patients the recurrent sroke was fatal and 2 (1.4%) patients had lethal outcome due to heart failure deterioration after 6 months of follow up. During one year follow up 27 (19.4%) patients had spontaneous AF conversion into sinus rhythm and 19 (13.7%) patients underwent successful catheter ablation. The adjusted risk of reccurent stroke for those in chronic AF was higher than in sinus rhythm (hazard ratio, 1.70; 95% CI, 1.37–2.12). Conclusions This study showed that patients with newly dignosed AF and cardioembolic stroke are characterized with polymorbidity and high thromboembolic risk but after sinus rhythm restoration the adjusted risk of reccurent stroke is much lower. The results demonstrate a low quality care of patients with AF and cardioembolic stroke at the outpatient stage. Appropriate medication compliance is crucial for positive outcomes as well as effectivesecondary stroke prevention in AF patients. FUNDunding Acknowledgement Type of funding sources: None.

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Small Conductance Ca2 +-Activated K+ (SK) Channel mRNA Expression in Human Atrial and Ventricular Tissue: Comparison Between Donor, Atrial Fibrillation and Heart Failure Tissue

Frontiers in Physiology ◽

10.3389/fphys.2021.650964 ◽

2021 ◽

Vol 12 ◽

Author(s):

Elisa Darkow ◽

Thong T. Nguyen ◽

Marina Stolina ◽

Fabian A. Kari ◽

Constanze Schmidt ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Sinus Rhythm ◽

Cardiac Disease ◽

Differentially Expressed ◽

Sk Channels ◽

Expression Levels ◽

Ventricular Tissue ◽

Small Conductance ◽

Selective Target

In search of more efficacious and safe pharmacological treatments for atrial fibrillation (AF), atria-selective antiarrhythmic agents have been promoted that target ion channels principally expressed in the atria. This concept allows one to engage antiarrhythmic effects in atria, but spares the ventricles from potentially proarrhythmic side effects. It has been suggested that cardiac small conductance Ca2+-activated K+ (SK) channels may represent an atria-selective target in mammals including humans. However, there are conflicting data concerning the expression of SK channels in different stages of AF, and recent findings suggest that SK channels are upregulated in ventricular myocardium when patients develop heart failure. To address this issue, RNA-sequencing was performed to compare expression levels of three SK channels (KCNN1, KCNN2, and KCNN3) in human atrial and ventricular tissue samples from transplant donor hearts (no cardiac disease), and patients with cardiac disease in sinus rhythm or with AF. In addition, for control purposes expression levels of several genes known to be either chamber-selective or differentially expressed in AF and heart failure were determined. In atria, as compared to ventricle from transplant donor hearts, we confirmed higher expression of KCNN1 and KCNA5, and lower expression of KCNJ2, whereas KCNN2 and KCNN3 were statistically not differentially expressed. Overall expression of KCNN1 was low compared to KCNN2 and KCNN3. Comparing atrial tissue from patients with AF to sinus rhythm samples we saw downregulation of KCNN2 in AF, as previously reported. When comparing ventricular tissue from heart failure patients to non-diseased samples, we found significantly increased ventricular expression of KCNN3 in heart failure, as previously published. The other channels showed no significant difference in expression in either disease. Our results add weight to the view that SK channels are not likely to be an atria-selective target, especially in failing human hearts, and modulators of these channels may prove to have less utility in treating AF than hoped. Whether targeting SK1 holds potential remains to be elucidated.

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