Abstract 25: Left Atrial Volume Index is Associated With Atrial Fibrillation and Recurrent Stroke in Embolic Stroke of Undetermined Source (ESUS)

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jamie S Ho ◽  
Ching-Hui Sia ◽  
Yushan Boi ◽  
Anthia S Foo ◽  
Mayank Dalakoti ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Left Atrial ◽  
Recurrent Stroke ◽  
Left Atrial Volume ◽  
Embolic Stroke ◽  
Volume Index ◽  
Stroke Recurrence ◽  
Atrial Volume ◽  
Left Atrial Volume Index ◽  
Kaplan Meier

In ESUS, the relationship between atrial cardiopathy, occult AF and embolic stroke risk remains unclear. Studies suggest that left atrial volume index (LAVi) may be a better estimate of atrial cardiopathy than LA diameter. We explored LAVi as a marker of occult AF detection and ischemic stroke recurrence. Methods: From 2015-2017, consecutive ESUS patients diagnosed based on consensus criteria were studied. LAVi was measured using the Biplane Area-Length Method on TTE by trained cardiologists. Clinical outcomes measured were occult AF detection and ischemic stroke recurrence in a time-to-event analysis. Kaplan-Meier curves were constructed to compare outcomes in those with high versus low LAVi at optimized cut-off values. Results: 199 consecutive ESUS patients were followed up for 2.2±1.0 years. 9 patients were excluded due to technically inadequate views. Increased LAVi was associated with AF detection (36.63mL/m 2 ± 12.2 vs 26.93mL/m 2 ± 9.6) and stroke recurrence (32.13mL/m 2 ± 9.3 vs 27.23mL/m 2 ± 10.1). On multivariate regression adjusting for age, sex, hypertension and diabetes mellitus, LAVI was independently associated with AF detection (OR 1.08, CI 95% 1.03-1.14; p=0.003) and stroke recurrence (OR 1.05, CI 95% 1.01-1.10; p=0.026). Kaplan-Meier curves showed significant differences in occult AF (log-rank 8.67, p=0.003) and stroke recurrence (log-rank 5.31, p=0.021) between high (>27.7ml/m 2 ) and low LAVi (≤27.7ml/m 2 ) groups. Conclusion: Increased LAVi in ESUS patients was associated with AF detection and stroke recurrence, suggesting that this may be a useful echocardiographic marker to identify high-risk patients who may potentially benefit from anticoagulation.

Left Atrial Volume Index Predicts New-Onset Atrial Fibrillation and Stroke Recurrence in Patients with Embolic Stroke of Undetermined Source

2020 ◽  
Vol 49 (3) ◽  
pp. 285-291
Author(s):  
Benjamin Y.Q. Tan ◽  
Jamie Sin Ying Ho ◽  
Ching-Hui Sia ◽  
Yushan Boi ◽  
Anthia S.M. Foo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Volume Index ◽  
Stroke Recurrence ◽  
Atrial Volume ◽  
Left Atrial Volume Index ◽  
Onset Atrial Fibrillation ◽  
New Onset

Introduction: It is unclear which surrogate of atrial cardiopathy best predicts the risk of developing a recurrent ischemic stroke in embolic stroke of undetermined source (ESUS). Left atrial diameter (LAD) and LAD index (LADi) are often used as markers of left atrial enlargement in current ESUS research, but left atrial volume index (LAVi) has been found to be a better predictor of cardiovascular outcomes in other patient populations. Objective: We aim to compare the performance of LAVi, LAD, and LADi in predicting the development of new-onset atrial fibrillation (AF) and stroke recurrence in ESUS. Methods: Between October 2014 and October 2017, consecutive patients diagnosed with ESUS were followed for new-onset AF, ischemic stroke recurrence, and a composite outcome of occult AF and stroke recurrence. LAVi and LADi were measured by transthoracic echocardiogram; “high” LAVi was defined as ≥35 mL/m2 in accordance with American Society of Echocardiography guidelines. Results: 185 ischemic stroke patients with ESUS were recruited and followed for a median duration of 2.1 years. Increased LAVi was associated with new-onset AF detection (aOR 1.08; 95% CI 1.03–1.14; p = 0.003) and stroke recurrence (aOR 1.05; 95% CI 1.01–1.10; p = 0.026). Patients with “high” LAVi had a higher likelihood of developing a composite of AF detection and stroke recurrence (HR 3.45; 95% CI 1.55–7.67; p = 0.002). No significant association was observed between LADi and either occult AF or stroke recurrence. Conclusions: LAVi is associated with new-onset AF and stroke recurrence in ESUS patients and may be a better surrogate of atrial cardiopathy.

Abstract 11212: Left Atrial Volume Index Predicts Recurrence of Stroke in Patients With Non-Sustained Atrial Tachycardia

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Hyemoon Chung ◽  
Pil-Ki Min ◽  
Young Won Yoon ◽  
Byoung-Kwon Lee ◽  
Bum-Kee Hong ◽  
...  
Keyword(s):  
Left Atrial ◽  
Atrial Tachycardia ◽  
Left Atrial Volume ◽  
Holter Monitoring ◽  
Volume Index ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
Atrial Volume ◽  
Left Atrial Volume Index

Introduction: NSAT is known to appear more frequently in patients with paroxysmal AF. Additionally enlarged LA is considered to be an independent risk factor for newly diagnosed AF. We investigated the relationship between non-sustained atrial tachycardia (NSAT) and stroke recurrence and the risk factors that may predict stroke recurrence in stroke patients where 24-hour Holter monitoring documented NSAT without paroxysmal AF. Hypothesis: We hypothesized that those patients who presented with NSAT and enlarged LA would have a higher incidence of stroke recurrence. Methods: 214 patients (102 males, mean 70±11 years) with acute ischemic stroke and NSAT were subject to 24-hour Holter monitoring. During follow-up patients were assessed for stroke recurrence and echocardiographic parameters. Results: During a mean follow-up period of 36±34 months, the recurrence rate of stroke was 11.8% (25 of 214). Those patients with recurrence had a larger LA diameter (34.73±5.04 vs. 40.64±3.45mm, p<0.001), LA volume index (LAVI, 22.56±5.86vs. 33.81±7.80 ml/m 2 , p<0.001and increased E/E’ (12.27±4.86 vs. 14.49±4.38, p=0.032) compared to patients without recurrence (n=189). A Kaplan-Meier survival rate was significantly lower in patients with enlarged LA size (LAVI>28 mm 3 /m 2 ) compared with patients without enlarged LA size (LAVI≤28 mm 3 /m 2 ) (p<0.001 by log-rank test). Cox regression analysis revealed that left atrial volume index hazard ratio (HR: 1.148, 95% CI: 1.092-1.206, p<0.001) was an independent predictor for stroke recurrence in patients with NSAT. Areas under the Receiver Operating Characteristics (ROC) curve of LAVI for recurrence of stroke was 0.876 (95% CI: 0.791-0.960, p<0.001). Conclusions: In patients with acute ischemic stroke and NSAT, increased LAVI predicts an increased risk of stroke recurrence. This study supports the potential use of anticoagulants in stroke patients with NSAT and increased LAVI without documented AF to reduce recurrent stroke.

The Role of Left Atrial Volume Index in Patients with a First-ever Acute Ischemic Stroke

2017 ◽  
Vol 26 (2) ◽  
pp. 321-326 ◽  
Author(s):  
Murat Biteker ◽  
Kadir Kayataş ◽  
Özcan Başaran ◽  
Volkan Dogan ◽  
Eda Özlek ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Volume Index ◽  
Atrial Volume ◽  
Left Atrial Volume Index

Increased Left Atrial Volume Index: Potent Biomarker for First-Ever Ischemic Stroke

2008 ◽  
Vol 83 (10) ◽  
pp. 1107-1114 ◽  
Author(s):  
Kaniz Fatema ◽  
Kent R. Bailey ◽  
George W. Petty ◽  
Irene Meissner ◽  
Martin Osranek ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Volume Index ◽  
Atrial Volume ◽  
Left Atrial Volume Index

P1017Thoracoscopic AF ablation is a successful treatment for patients with a giant left atrium

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Neefs ◽  
R Wesselink ◽  
M M Terpstra ◽  
N W E Van Den Berg ◽  
W R Berger ◽  
...  
Keyword(s):  
Left Atrium ◽  
Left Atrial ◽  
Atrial Tachycardia ◽  
Left Atrial Volume ◽  
Volume Index ◽  
Atrial Volume ◽  
Left Atrial Volume Index ◽  
Af Ablation ◽  
Kaplan Meier

Abstract Background Severely enlarged left atrial (LA) volume is associated with a considerable ineffective outcome of ablation for atrial fibrillation (AF). Therefore, in patients with AF and a giant atrial volume catheter ablation is not recommended. However, thoracoscopic AF ablation is being performed in patients with AF and giant LA, but with unknown efficacy. Purpose To determine efficacy of thoracoscopic AF ablation in patients with AF and a giant LA. Methods Patients underwent thoracoscopic AF ablation (paroxysmal AF) plus additional left atrial ablations (persistent AF) and were prospectively followed. Giant LA was defined as left atrial volume index (LAVI)≥50 ml/m2, outcome was also assessed for LAVI≥55 ml/m2. Follow-up was performed with ECGs and 24-hour Holters every three months. After a 3-month blanking period, all AADs were discontinued. Primary outcome was recurrence of any atrial tachycardia ≥30 sec during one year of follow-up. Results Between 2008–2017, 357 patients underwent thoracoscopic AF ablation. At baseline, giant LA was diagnosed in 72 (20.2%) patients (mean LAVI: 59.5±9.6 ml/m2), while 285 (79.8%) had a smaller left atrium (mean LAVI: 36.3±7.8 ml/m2), p<0.001. Giant LA patients were older (mean: 61.7±6.9 vs 59.3±9.0 years, p=0.03) and more often diagnosed with persistent AF (n=60, 83.3%) compared to control (n=164, 57.5%), p<0.001. Sex (female: n=19, 26.4% vs n=79, 27.7%, p=0.82) and history of AF (median: 4.0 [IQR: 2.0–6.0] vs 4.0 [IQR: 2.0–8.0] years, p=0.10) were equally distributed. Freedom of any atrial tachycardia did not differ significantly between both groups (n=43, 59.7% vs n=195, 68.4%, log rank p=0.91), figure. This was similar for the cut-off of LAVI≥55 ml/m2: n=24/43 (55.8%) vs n=214/314 (68.2%), p=0.15). AF recurred in 16 (22.2%) patients with giant LA compared to 55 (19.3%) patients, while atrial tachycardia recurred in 21 (29.2%) vs 56 (19.6%) patients, respectively, p=0.06. Kaplan-Meier analysis of AF recurrence i Conclusion Thoracoscopic AF ablation is an effective therapy in patients with a giant LA. Thoracoscopic AF ablation may therefore be a feasible treatment for patients with a giant LA.

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