Echocardiographic predictors of occult atrial fibrillation in patients with cryptogenic stroke

Abstract

Abstract Background Left atrial (LA) strain has been proposed as an echocardiographic predictor of subsequent atrial fibrillation (AF) in patients presenting with cryptogenic stroke (CS). The purpose of this study was to compare the predictive value of LA strain parameters with traditional echocardiographic measurements for predicting occult AF in patients with CS. Methods We conducted a single-center retrospective cohort study of patients with cryptogenic stroke who underwent implantable cardiac monitor (ICM) placement. Transthoracic echocardiogram (TTE) parameters collected included mitral e and e’ velocities, and LA volume index (LAVI). LA strain was calculated offline using speckle-tracking in apical 4 and 2 chamber views, during the reservoir, conduit, and contractile phases of the cardiac cycle. Strain measurements obtained in each view were averaged (Figure 1). AF episodes had to last at least 2 minutes to qualify as an AF event. Results The cohort consisted of 269 patients with cryptogenic stroke who underwent ICM placement between April 2015 to December 2020, of them 45 patients had AF detected by ICM during follow-up. Echocardiographic evidence of dilated LA measured using LAVI (p=0.043) as well as lower filling pressures measured using e/e’ (p=0.033) were significantly associated with AF. (Table 1). LA function using strain in reservoir, conduit, and contractile phases was not significantly associated with AF (Table 1). Conclusion Increased LA size, but not abnormal LA function was significantly associated with incident AF in patients with CS.