Left Atrial Expansion Index for Ischemic Stroke Prediction in Patients with Atrial Fibrillation

Overview

Journal Acta Cardiol Sin

Date 2024 Jan 24

PMID 38264078

Authors

Jau-Wen Shiau

Chao-Sheng Hsiao

Shih-Hung Hsiao

Affiliations

Soon will be listed here.

Abstract

Background: The efficacy of the left atrial (LA) expansion index (LAEI) to predict cerebral ischemic events in patients with atrial fibrillation (AF) is unknown.

Methods: We enrolled 177 patients with AF (88 with paroxysmal AF and 89 with persistent AF) and a baseline CHADS-VASc score (at enrollment) of 3.6 ± 2.3. Comprehensive echocardiography was performed at enrollment. The LAEI was calculated as (Vol - Vol) × 100%/Vol, where Vol and Vol denoted maximal and minimal LA volumes, respectively. The study endpoint was ischemic stroke. Stroke subtypes were classified into cardioembolic stroke (CE), non-CE with determined mechanism (NCE), embolic stroke of undetermined source (ESUS), or transient ischemic attack (TIA).

Results: Over a mean 9.9-year follow-up period, 44 (24.9%) of the patients reached the endpoint (24 with CE, 4 with NCE, 6 with ESUS, and 10 with TIA). The LAEI was lower in the stroke group than in the non-stroke group. Stroke incidence in the lowest LAEI quartile was much higher than that in the other LAEI quartiles; the 10-year cumulative stroke risk was 15.9% (14/88) and 33.7% (30/89) in the patients with paroxysmal and persistent AF, respectively. An LAEI of < 35% predicted the presence of stroke with 77% sensitivity and 78% specificity. In multivariable analysis, the LAEI was independently associated with ischemic stroke (hazard ratio 0.952 per 1% increase, 95% confidence interval 0.932-0.971, p < 0.0001).

Conclusions: The LAEI is a useful predictor of ischemic stroke in patients with AF.

References

Hsiao S, Lin K, Chiou K . Comparison of left atrial volume parameters in detecting left ventricular diastolic dysfunction versus tissue Doppler recordings. Am J Cardiol. 2011; 109(5):748-55. DOI: 10.1016/j.amjcard.2011.10.040. View

Ujino K, Barnes M, Cha S, Langins A, Bailey K, Seward J . Two-dimensional echocardiographic methods for assessment of left atrial volume. Am J Cardiol. 2006; 98(9):1185-8. DOI: 10.1016/j.amjcard.2006.05.040. View

De With R, Marcos E, Van Gelder I, Rienstra M . Atrial fibrillation progression and outcome in patients with young-onset atrial fibrillation. Europace. 2018; 20(11):1750-1757. DOI: 10.1093/europace/euy028. View

Olsen F, Bertelsen L, Knegt M, Christensen T, Vejlstrup N, Svendsen J . Multimodality Cardiac Imaging for the Assessment of Left Atrial Function and the Association With Atrial Arrhythmias. Circ Cardiovasc Imaging. 2016; 9(10). DOI: 10.1161/CIRCIMAGING.116.004947. View

Barnes M, Miyasaka Y, Seward J, Gersh B, Rosales A, Bailey K . Left atrial volume in the prediction of first ischemic stroke in an elderly cohort without atrial fibrillation. Mayo Clin Proc. 2004; 79(8):1008-14. DOI: 10.4065/79.8.1008. View

de Vos C, Pisters R, Nieuwlaat R, Prins M, Tieleman R, Coelen R . Progression from paroxysmal to persistent atrial fibrillation clinical correlates and prognosis. J Am Coll Cardiol. 2010; 55(8):725-31. DOI: 10.1016/j.jacc.2009.11.040. View

Hsiao S, Chiou K . Left atrial expansion index predicts atrial fibrillation in dyspnea. Circ J. 2013; 77(11):2712-21. DOI: 10.1253/circj.cj-13-0463. View

Kuppahally S, Akoum N, Burgon N, Badger T, Kholmovski E, Vijayakumar S . Left atrial strain and strain rate in patients with paroxysmal and persistent atrial fibrillation: relationship to left atrial structural remodeling detected by delayed-enhancement MRI. Circ Cardiovasc Imaging. 2010; 3(3):231-9. DOI: 10.1161/CIRCIMAGING.109.865683. View

Liao J, Chao T, Hung C, Chen S . The decrease in peak atrial longitudinal strain in patients with atrial fibrillation as a practical parameter for stroke risk stratification. Heart Rhythm. 2021; 18(4):538-544. DOI: 10.1016/j.hrthm.2020.12.026. View

10.

Nattel S, Guasch E, Savelieva I, Cosio F, Valverde I, Halperin J . Early management of atrial fibrillation to prevent cardiovascular complications. Eur Heart J. 2014; 35(22):1448-56. DOI: 10.1093/eurheartj/ehu028. View

11.

Ommen S, Nishimura R, Hurrell D, Klarich K . Assessment of right atrial pressure with 2-dimensional and Doppler echocardiography: a simultaneous catheterization and echocardiographic study. Mayo Clin Proc. 2000; 75(1):24-9. DOI: 10.4065/75.1.24. View

12.

. Echocardiographic predictors of stroke in patients with atrial fibrillation: a prospective study of 1066 patients from 3 clinical trials. Arch Intern Med. 1998; 158(12):1316-20. DOI: 10.1001/archinte.158.12.1316. View

13.

Hsiao S, Huang W, Lin K, Chiou K, Kuo F, Lin S . Left atrial distensibility and left ventricular filling pressure in acute versus chronic severe mitral regurgitation. Am J Cardiol. 2010; 105(5):709-15. DOI: 10.1016/j.amjcard.2009.10.052. View

14.

Ohara K, Hirai T, Fukuda N, Sakurai K, Nakagawa K, Nozawa T . Relation of left atrial blood stasis to clinical risk factors in atrial fibrillation. Int J Cardiol. 2008; 132(2):210-5. DOI: 10.1016/j.ijcard.2007.11.012. View

15.

Sohns C, Marrouche N . Atrial fibrillation and cardiac fibrosis. Eur Heart J. 2019; 41(10):1123-1131. DOI: 10.1093/eurheartj/ehz786. View

16.

Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B . 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016; 37(38):2893-2962. DOI: 10.1093/eurheartj/ehw210. View

17.

. American Diabetes Association: clinical practice recommendations 1997. Diabetes Care. 1997; 20 Suppl 1:S1-70. View

18.

Benjamin E, DAgostino R, Belanger A, Wolf P, Levy D . Left atrial size and the risk of stroke and death. The Framingham Heart Study. Circulation. 1995; 92(4):835-41. DOI: 10.1161/01.cir.92.4.835. View

19.

Cameli M, Mandoli G, Loiacono F, Sparla S, Iardino E, Mondillo S . Left atrial strain: A useful index in atrial fibrillation. Int J Cardiol. 2016; 220:208-13. DOI: 10.1016/j.ijcard.2016.06.197. View

20.

Liao J, Chao T, Kuo J, Sung K, Tsai J, Lo C . Global Left Atrial Longitudinal Strain Using 3-Beat Method Improves Risk Prediction of Stroke Over Conventional Echocardiography in Atrial Fibrillation. Circ Cardiovasc Imaging. 2020; 13(8):e010287. DOI: 10.1161/CIRCIMAGING.119.010287. View