Abstract 12671: Left Atrial Volumes Corrected for Heart Size are Superior Echocardiographic Measures for Diagnosing Paroxysmal Atrial Fibrillation in Ischemic Stroke and Transient Ischemic Attack Patients

Abstract

Introduction: The underlying cause of ischemic strokes (IS) and transient ischemic attacks (TIA) is not identified in 25% of the cases. However, asymptomatic paroxysmal atrial fibrillation (PAF) is often assumed to be the cause of the cryptogenic IS or TIA Hypothesis: The aim of this study was to examine if echocardiographic measures of LA volume (LAV) corrected for the left ventricular (LV) length (LAVMax/Min/LV length) could predict PAF in patients with IS and TIA. Methods: We retrospectively included 218 patients who after acute IS or TIA underwent a transthoracic echocardiographic examination in sinus rhythm. Patients were designated as PAF-patients if they had one or more reported incidents of AF before or after their echocardiographic examination. Results: Patients in the PAF group were significantly older (62±13 vs. 52±14 years, p<0.001), had higher CHA2DS2-VASc score (3.3±1.3 vs. 3.8±1.3, p=0.042) and higher National Institutes of Health Stroke Scale (NIHSS) score (2.9±4.9 vs. 1.4±3.3, p=0.016) than patients without PAF. Besides these, no other baseline characteristics (sex, hypertension, diabetes, cholesterol) were associated with PAF. None of the conventional echocardiographic parameters (LV ejection fraction, LV volumes, E/A-ratio, E-wave deceleration time, LAVmax) were significantly associated with PAF. However, the atrial measures corrected for LV length (LAVMax/LV length and LAVMin/LV length) were significantly higher (LAVMax/LV length: 7.6±3.3 mL/cm vs. 6.5± 2.0 mL/cm, p=0.009; LAVMin/LV length: 3.7± 2.1 mL/cm vs. 2.8±1.1 mL/cm, p<0.001) in patients with PAF (Figure), even after adjustment for age, gender, CHA2DS2-VASc and NIHSS scores. Conclusion: In patients with IS and TIA, measures of LA size corrected for LV length are independently associated with the presence of PAF. Applying these may yield better risk stratification for PAF-presence in patients suffering cryptogenic IS and TIA.