Septal Total Atrial Conduction Time for Prediction of Atrial Fibrillation in Embolic Stroke of Unknown Source: a Pilot Study

Overview

Journal Clin Res Cardiol

Specialty Cardiology & Vascular Diseases

Date 2019 Jun 26

PMID 31236691

Citations 15

Authors

Jan-Thorben Sieweke

Saskia Biber

Karin Weissenborn

Peter U Heuschmann

Muharrem Akin

Florian Zauner

Maria M Gabriel

Ramona Schuppner

Dominik Berliner

Johann Bauersachs

Gerrit M Grosse

Udo Bavendiek

Affiliations

Soon will be listed here.

Abstract

Background: Subclinical atrial fibrillation (AF) is the underlying cause in a relevant part of patients with embolic stroke of unknown source (ESUS). This pilot study aims to identify novel echocardiographic parameters predicting AF subsequently detected in patients originally hospitalized with ESUS.

Methods And Results: Patients with acute ischemic stroke [baseline diagnosis of ESUS (n = 69), stroke of macro- or microvascular cause (n = 16/25), stroke caused by AF (n = 5)] and controls with paroxysmal AF without acute ischemic stroke (n = 22) as well as healthy controls of young and old age (n = 21/17) in sinus rhythm were included (overall n = 175). Echocardiography was performed in all participants. Prolonged Holter-ECG-monitoring was performed in all stroke patients. In the overall cohort, septal total atrial conduction time (sPA-TDI), left atrial (LA) volume index to tissue Doppler velocity (LAVI/a`) and second negative peak strain rate during LA contraction (SRa), representing echocardiographic parameters of LA remodelling and function, were statistically significant different in patients with and without AF and predictive for subclinical AF (multivariate regression analysis: sPA-TDI: HR 1.06 [1.04-1.08], p < 0.001; LAVI/a`: HR 0.85, [0.74-0.97], p = 0.02; SRa: HR 2.35 [0.9-5.5], p = 0.05). Multivariate Cox regression analysis revealed sPA-TDI as an independent predictor of AF in ESUS patients (sPA-TDI: HR 1.10 [1.04-1.17], p = 0.001). A sPA-TDI of 126 ms strictly discriminated between presence and absence of subclinical AF within 48 h after initiation of Holter-ECG-monitoring in ESUS patients.

Conclusions: sPA-TDI seems to be a strong independent predictor of subclinical AF in patients hospitalized for ESUS and might support risk-stratified clinical decision making in these patients. Septal Total Atrial Conduction Time (sPA-TDI) determined by echocardiography for prediction of Atrial Fibrillation in Embolic Stroke of Unknown Source (ESUS).

Citing Articles

Non-invasive prediction of atrial cardiomyopathy characterized by multipolar high-density contact mapping.

Huttelmaier M, Gabel A, Herting J, Vogel M, Stork S, Frantz S J Interv Card Electrophysiol. 2025; .

PMID: 39899140 DOI: 10.1007/s10840-025-02001-2.

Left Ventricular Diastolic Dysfunction with Elevated Filling Pressures Is Associated with Embolic Stroke of Undetermined Source and Atrial Fibrillation.

Bashir Z, Shu L, Guo Y, Chen E, Wang S, Goldstein E Tomography. 2024; 10(10):1694-1705.

PMID: 39453041 PMC: 11511054. DOI: 10.3390/tomography10100124.

The Role of Galectin-3 Levels for Predicting Paroxysmal Atrial Fibrillation in Patients with Embolic Stroke of Undetermined Source.

Calapkorur B, Demirci E, Baran O, Ulusoy E, Kocer D, Demirelli S J Clin Med. 2024; 13(11).

PMID: 38892886 PMC: 11172436. DOI: 10.3390/jcm13113175.

Deep learning evaluation of echocardiograms to identify occult atrial fibrillation.

Yuan N, Stein N, Duffy G, Sandhu R, Chugh S, Chen P NPJ Digit Med. 2024; 7(1):96.

PMID: 38615104 PMC: 11016113. DOI: 10.1038/s41746-024-01090-z.

Echocardiographic parameters indicating left atrial reverse remodeling after catheter ablation for atrial fibrillation.

Angelini E, Sieweke J, Berliner D, Biber S, Hohmann S, Oldhafer M Front Cardiovasc Med. 2024; 10:1270422.

PMID: 38164465 PMC: 10757954. DOI: 10.3389/fcvm.2023.1270422.

References

Haeusler K, Groschel K, Kohrmann M, Anker S, Brachmann J, Bohm M . Expert opinion paper on atrial fibrillation detection after ischemic stroke. Clin Res Cardiol. 2018; 107(10):871-880. DOI: 10.1007/s00392-018-1256-9. View

Schumacher K, Dagres N, Hindricks G, Husser D, Bollmann A, Kornej J . Characteristics of PR interval as predictor for atrial fibrillation: association with biomarkers and outcomes. Clin Res Cardiol. 2017; 106(10):767-775. DOI: 10.1007/s00392-017-1109-y. View

den Uijl D, Gawrysiak M, Tops L, Trines S, Zeppenfeld K, Schalij M . Prognostic value of total atrial conduction time estimated with tissue Doppler imaging to predict the recurrence of atrial fibrillation after radiofrequency catheter ablation. Europace. 2011; 13(11):1533-40. DOI: 10.1093/europace/eur186. View

Bembenek J, Karlinski M, Kurkowska-Jastrzebska I, Czlonkowska A . Embolic strokes of undetermined source in a cohort of Polish stroke patients. Neurol Sci. 2018; 39(6):1041-1047. PMC: 5966493. DOI: 10.1007/s10072-018-3322-5. View

Kernan W, Ovbiagele B, Black H, Bravata D, Chimowitz M, Ezekowitz M . Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014; 45(7):2160-236. DOI: 10.1161/STR.0000000000000024. View

Geisler T, Poli S, Meisner C, Schreieck J, Zuern C, Nagele T . Apixaban for treatment of embolic stroke of undetermined source (ATTICUS randomized trial): Rationale and study design. Int J Stroke. 2016; 12(9):985-990. DOI: 10.1177/1747493016681019. View

Lang R, Badano L, Mor-Avi V, Afilalo J, Armstrong A, Ernande L . Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015; 16(3):233-70. DOI: 10.1093/ehjci/jev014. View

Muller P, Schiedat F, Bialek A, Bosche L, Ewers A, Kara K . Total atrial conduction time assessed by tissue doppler imaging (PA-TDI Interval) to predict early recurrence of persistent atrial fibrillation after successful electrical cardioversion. J Cardiovasc Electrophysiol. 2013; 25(2):161-7. DOI: 10.1111/jce.12306. View

Muller P, Hars C, Schiedat F, Bosche L, Gotzmann M, Strauch J . Correlation between total atrial conduction time estimated via tissue Doppler imaging (PA-TDI Interval), structural atrial remodeling and new-onset of atrial fibrillation after cardiac surgery. J Cardiovasc Electrophysiol. 2013; 24(6):626-31. DOI: 10.1111/jce.12084. View

10.

Pirinen J, Putaala J, Lehto M . Details on methods and further thoughts on P-wave indices in stroke: Response to the letter "Importance of P-wave indices in stroke", by Chhabra L, regarding "Resting 12-lead electrocardiogram reveals high-risk sources of cardioembolism in young.... Int J Cardiol. 2016; 216:66-7. DOI: 10.1016/j.ijcard.2016.04.034. View

11.

Nagueh S, Smiseth O, Appleton C, Byrd 3rd B, Dokainish H, Edvardsen T . Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2016; 17(12):1321-1360. DOI: 10.1093/ehjci/jew082. View

12.

Gladstone D, Spring M, Dorian P, Panzov V, Thorpe K, Hall J . Atrial fibrillation in patients with cryptogenic stroke. N Engl J Med. 2014; 370(26):2467-77. DOI: 10.1056/NEJMoa1311376. View

13.

Stahrenberg R, Edelmann F, Haase B, Lahno R, Seegers J, Weber-Kruger M . Transthoracic echocardiography to rule out paroxysmal atrial fibrillation as a cause of stroke or transient ischemic attack. Stroke. 2011; 42(12):3643-5. DOI: 10.1161/STROKEAHA.111.632836. View

14.

Goette A, Kalman J, Aguinaga L, Akar J, Cabrera J, Chen S . EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication. Europace. 2016; 18(10):1455-1490. PMC: 6392440. DOI: 10.1093/europace/euw161. View

15.

Schneider C, Malisius R, Krause K, Lampe F, Bahlmann E, Boczor S . Strain rate imaging for functional quantification of the left atrium: atrial deformation predicts the maintenance of sinus rhythm after catheter ablation of atrial fibrillation. Eur Heart J. 2008; 29(11):1397-409. DOI: 10.1093/eurheartj/ehn168. View

16.

Becker M, Bilke E, Kuhl H, Katoh M, Kramann R, Franke A . Analysis of myocardial deformation based on pixel tracking in two dimensional echocardiographic images enables quantitative assessment of regional left ventricular function. Heart. 2006; 92(8):1102-8. PMC: 1861114. DOI: 10.1136/hrt.2005.077107. View

17.

Antoni M, Bertini M, Atary J, Delgado V, ten Brinke E, Boersma E . Predictive value of total atrial conduction time estimated with tissue Doppler imaging for the development of new-onset atrial fibrillation after acute myocardial infarction. Am J Cardiol. 2010; 106(2):198-203. DOI: 10.1016/j.amjcard.2010.02.030. View

18.

Blessberger H, Binder T . NON-invasive imaging: Two dimensional speckle tracking echocardiography: basic principles. Heart. 2010; 96(9):716-22. DOI: 10.1136/hrt.2007.141002. View

19.

Donal E, Lip G, Galderisi M, Goette A, Shah D, Marwan M . EACVI/EHRA Expert Consensus Document on the role of multi-modality imaging for the evaluation of patients with atrial fibrillation. Eur Heart J Cardiovasc Imaging. 2016; 17(4):355-83. DOI: 10.1093/ehjci/jev354. View

20.

Srivastava P, Burrell L, Calafiore P . Lateral vs medial mitral annular tissue Doppler in the echocardiographic assessment of diastolic function and filling pressures: which should we use?. Eur J Echocardiogr. 2005; 6(2):97-106. DOI: 10.1016/j.euje.2004.07.005. View