scholarly journals Left Atrium Assessment by Speckle Tracking Echocardiography in Cryptogenic Stroke: Seeking Silent Atrial Fibrillation

2021 ◽  
Vol 10 (16) ◽  
pp. 3501
Author(s):  
Mireia Ble ◽  
Begoña Benito ◽  
Elisa Cuadrado-Godia ◽  
Sílvia Pérez-Fernández ◽  
Miquel Gómez ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Cryptogenic Stroke ◽  
Multivariate Logistic Regression Analysis ◽  
Disease Diagnosis ◽  
Atrial Volume ◽  
Atrial Enlargement ◽  
Atrial Strain

Silent atrial fibrillation (AF) may be the cause of some cryptogenic strokes (CrS). The aim of the study was to analyse atrial size and function by speckle tracking echocardiography in CrS patients to detect atrial disease. Patients admitted to the hospital due to CrS were included prospectively. Echocardiogram analysis included left atrial ejection fraction (LAEF) and atrial strain. Insertable cardiac monitor was implanted, and AF was defined as an episode of ≥1 min in the first year after stroke. Left atrial enlargement was defined as indexed volume > 34 mL/m2. Seventy-five consecutive patients were included, aged 76 ± 9 years (arterial hypertension 75%). AF was diagnosed in 49% of cases. The AF group had higher atrial volume and worse atrial function: peak atrial longitudinal strain (PALs) 19.6 ± 5.7% vs. 29.5 ± 7.2%, peak atrial contraction strain (PACs) 8.9 ± 3.9% vs. 16.5 ± 6%, LAEF 46.8 ± 11.5% vs. 60.6 ± 5.2%; p < 0.001. AF was diagnosed in 20 of 53 patients with non-enlarged atrium, and in 18 of them, atrial dysfunction was present. The multivariate logistic regression analysis demonstrated an independent association between detection of AF and atrial volume, LAEF, and strain. Cut-off values were obtained: LAEF < 55%, PALs < 21.4%, and PACs < 12.9%. In conclusion, speckle tracking echocardiography in CrS patients improves silent atrial disease diagnosis, with or without atrial enlargement.

scholarly journals Utility of Speckle-Tracking Echocardiography For Predicting Atrial Fibrillation Following Ischemic Stroke: A Systematic Review And Meta-Analysis

2021 ◽  
Author(s):  
Qinggele Gao ◽  
Peng Liu ◽  
Tingting Lv ◽  
Ying Yang ◽  
Ping Zhang
Keyword(s):  
Atrial Fibrillation ◽  
Strain Rate ◽  
Left Atrial ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
Global Longitudinal Strain ◽  
Cryptogenic Stroke ◽  
Atrial Remodeling

Abstract Purpose: Undiagnosed atrial fibrillation (AF) is one of the main sources of cryptogenic stroke. And strain indices measured by speckle-tracking echocardiography are associated with atrial remodeling supposed to be the substrate of AF. Therefore, there is a strong need for evaluating the utility of speckle-tracking echocardiography to predict the likelihood of AF in patients with cryptogenic stroke.Methods: PubMed, Embase and Cochrane Database were searched for studies. The random-effects model was used to calculate the pooled results, and summary receiver operating characteristic curve (SROC) analysis was performed to show the overall predictive value.Results: There were 1483 patients with cryptogenic stroke from 8 studies. Meta-analysis showed that strain indices including global longitudinal strain (GLS) (mean difference [SMD]: -0.22, 95% confidence interval [95% CI]: -0.40 to -0.04) , left atrial reservoir strain (εR), (SMD: -0.87, 95% CI: -1.26 to -0.48, conduit strain (εCD) (SMD: -0.56, 95% CI: -0.81 to -0.30), contractile strain (εCT) (SMD: -1.00, 95% CI: -1.39 to -0.61), and left atrial reservoir strain rate (SRe) (SMD: -0.54, 95% CI: -0.80 to -0.28) measured at the period of cryptogenic stroke was significantly decreased in patients with AF occurrence compared to without. SROC analysis suggested an acceptable predictive efficiency of εR for AF occurrence (AUC = 0.799).Conclusion: For patients after cryptogenic stroke, GLS, εR, εCD, εCT and SRe were significantly decreased in AF occurrence compared with non-occurrence. But there was no value in left atrial reservoir strain rate (SRs) and contractile strain rate (SRa) for predicting AF.

Abstract P624: High Detection of Atrial Fibrillation by 90 Days Textil Holter Monitoring in Patients With Cryptogenic Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jorge Pagola ◽  
Jesus Juega ◽  
Jaume Francisco ◽  
Maite Rodriguez ◽  
Juan Antonio Cabezas ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cumulative Incidence ◽  
Left Atrial ◽  
Cryptogenic Stroke ◽  
Left Atrial Volume ◽  
Holter Monitoring ◽  
Cardiac Monitoring ◽  
Atrial Volume ◽  
Monitoring Time ◽  
Number Of Patients

Introduction: External recorders allow for low-cost, non-invasive 1 to 4 weeks monitoring. However, the first 3 months of monitoring duration are the most effective to detect atrial fibrillation (AF). We show the results of the Thunder registry of patients monitored to detect AF during 90 days from the stroke. Methods: A prospective observational study was conducted with consecutive inclusion of patients with cryptogenic stroke after work up (neuroimaging, echocardiography and 24-hour cardiac monitoring) in 5 Comprenhensive Stroke Centers. Patients were continuously monitored for 90 days with a wearable Holter (Nuubo®) after the first 24 hours of the stroke onset. We analyzed the percentage of AF detection in each period (percentage of AF among those monitored), the quality of the monitoring (monitoring time), the percentage of AF by intention to monitor (detection of AF among patient included). Demographic, clinical and echocardiographic predictors of AF detection beyond one week of cardiac monitoring were assessed. Results: A total of 254 patients were included. The cumulative incidence of AF detection at 90 days was 34.84%. The monitoring time was similar among the 3 months (30 days: 544.9 hours Vs 60 days: 505.9 hours Vs 90 days: 591.25 hours) (p=0.512). The number of patients who abandoned monitoring was 7% (18/254). The cumulative percentage of intention to detect AF was 30.88% (Figure). Patients who completed monitoring beyond 30 days had higher score on the NIHSS basal scale (NIHSS 9 IQR 2-17) VS (NIHSS 3 IQR 1-9) (p=0.024). Patients with left atrial volume greater than 28.5ml/m2 had higher risk of cumulative incidence of AF according to the Kaplan Meyer curve beyond the first week of monitoring OR 2.72 (Log-rank (Mantel-Cox test) (p<0.001). Conclusions: In conclusion, intensive 90-day- Holter monitoring with textile Holter was feasible and detected high percentage of AF. Enlarged left atrial volume predicted AF beyond the first week of monitoring.

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