A lower left atrial appendage peak emptying velocity in the acute phase of cryptogenic stroke predicts atrial fibrillation occurrence during follow‐up

Abstract

Background Silent atrial fibrillation is a frequent etiology of cryptogenic stroke. Spontaneous conversion of atrial fibrillation to sinus rhythm results in atrial stunning. Objective To evaluate if the presence of a lower left atrial appendage peak emptying velocity (LAAV) after a cryptogenic stroke is associated with the occurrence of atrial fibrillation (AF). Methods We retrospectively selected consecutive patients with an acute ischemic stroke that had a transoesophageal echocardiogram (TEE) performed in the first 30 days of the acute event. Documented AF or potential cardioembolic sources in the TEE were considered exclusion criteria. We assessed the LAAV. During follow‐up, we evaluated the occurrence of new‐onset AF and the combined endpoint of death or new ischemic stroke. Results We studied 73 consecutive patients, during a mean follow‐up period of 54.9 ± 19.3 months. Seven developed AF, and 13 had the combined endpoint. LAAV was independently associated with AF occurrence (HR: 0.93, 95% CI: 0.88–0.99; P = .016). Patients with a LAAV ≤ 46.5 cm/s (AUC: 0.766, 95% CI: 0.579–0.954; P = .021) had a lower survival rate free from AF occurrence (Log‐rank, P < .001) and free from the combined endpoint of death or ischemic stroke (Log‐rank, P = .010). Conclusion A lower LAAV was associated with AF occurrence and the combined endpoint of death or ischemic stroke after an initial episode of cryptogenic stroke. Patients with this finding could eventually benefit from long‐term cardiac rhythm monitoring.

Decreased left atrial appendage emptying velocity as a link between atrial fibrillation type, heart failure and older age and the risk of left atrial thrombus in atrial fibrillation

“…Thrombus formation begins with the Virchow's triad of stasis, endothelial dysfunction, and hypercoagulable state. LAAV is one of the most used parameters for evaluating atrial mechanical dysfunction associated with blood stasis 5,11,12 . In healthy individuals, LAAV ranges from 50 ± 6 cm/s to 83 ± 25 cm/s 5,11,12 .…”

“…LAAV is one of the most used parameters for evaluating atrial mechanical dysfunction associated with blood stasis 5,11,12 . In healthy individuals, LAAV ranges from 50 ± 6 cm/s to 83 ± 25 cm/s 5,11,12 . Velocities of less than 40 cm/s are associated with a higher risk of stroke, and velocities of less than 20 cm/s—with LAA thrombus and a higher incidence of thromboembolic events 5,13,14 .…”

Altered left atrial metrics in patients with cryptogenic stroke: A systematic review and meta‐analysis

“…We initially identified 6897 articles, with 4292 excluded as duplicates and 2402 excluded as nonrelevant based on title and abstract screening. Full text was examined in 200 articles, with 29 fulfilling inclusion criteria for data analysis 6,7,14–40 …”

The predictive value of the systemic immune-inflammatory index for left atrial appendage thrombus in non-valvular atrial fibrillation

“…In the current study, LAA emptying rate <20cm/sec was an independent predictor of LAA thrombus and this finding has been reported by several previous studies [26][27][28][29] . Reduced LAA velocity causing stasis is associated with LAA mechanical dysfunction [30][31][32] .…”