Atrial Cardiopathy: A Broadened Concept of Left Atrial Thromboembolism Beyond Atrial Fibrillation

Kamel, Hooman; Okin, Peter M.; Longstreth, W. T.; Elkind, Mitchell S.V.; Soliman, Elsayed Z

doi:10.2217/fca.15.22

Cited by 144 publications

(107 citation statements)

References 60 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…cvMRI may be cost-effective if available 24/7, replacing echocardiography (in a subset of stroke patients undergoing brain MRI and the complete cvMRI examination) and subsequently shortening the in-hospital stay after acute ischemic stroke. In addition, MRI is able to identify atrial cardio(myo)pathy 28 -a so far neglected source of cardiac embolism. Furthermore, cvMRI is also able to precisely characterize left atrial enlargement 17 independently associated with AF detection by an insertable cardiac monitor according to a recent study enrolling patients with cryptogenic stroke 29 -and the morphology of the left atrial appendage, another potential source of embolism (independent of AF).…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Diagnostic Value of Cardiovascular Magnetic Resonance Imaging After Acute Ischemic Stroke of Undetermined Origin

Hæusler

Wollboldt

Bentheim

et al. 2017

Stroke

View full text Add to dashboard Cite

E tiologic work-up is essential in patients with acute ischemic stroke to optimize secondary stroke prevention. According to international guidelines, state-of-the-art diagnostic work-up includes brain imaging, ultrasound of brainsupplying arteries, echocardiography, ECG monitoring, and distinct blood tests.1,2 However, stroke etiology remains undetermined (cryptogenic) in about 25% of all acute ischemic stroke patients. 3 Apart from nonpermanent atrial fibrillation (AF), 4 ventricular noncompaction, left atrial or ventricular thrombi, mitral or aortic valve stenosis, and ulcerated aortic arch atherosclerotic plaques are associated with a moderate to high embolic stroke risk and were found in a substantial part Background and Purpose-Etiology of acute ischemic stroke remains undetermined (cryptogenic) in about 25% of patients after state-of-the-art diagnostic work-up. Methods-One-hundred and three patients with magnetic resonance imaging (MRI)-proven acute ischemic stroke of undetermined origin were prospectively enrolled and underwent 3-T cardiac MRI and magnetic resonance angiography of the aortic arch in addition to state-of-the-art diagnostic work-up, including transesophageal echocardiography (TEE). We analyzed the feasibility, diagnostic accuracy, and added value of cardiovascular MRI (cvMRI) compared with TEE for detecting sources of stroke. Despite interstudy variations on the definition and prevalence of (potential) embolic sources, current guidelines recommend diagnostic echocardiography in stroke patients. 2Although noninvasive transthoracic echocardiography (TTE) is easy to use, semi-invasive transesophageal echocardiography (TEE) is typically needed to visualize the left atrium, left atrial appendage, atrial shunts, and the aortic arch-all of them potential sources of embolism.6 Serious complications during TEE rarely occur.7 However, required preprocedural fasting, periprocedural conscious sedation, and the demand of highly skilled personnel limit its availability and cause in-hospital delays. 8 In consequence, TEE is not routinely performed in (cryptogenic) stroke patients, even in high-income countries.9 Subsequently, assessment of potential embolic sources of ischemic stroke is often inappropriate in clinical practice. Although cardiac computed tomography could add information about stroke etiology, 10 the main disadvantage of this approach is the exposure to radiation. Cardiac magnetic resonance imaging (MRI) has been increasingly often implemented in the clinical diagnostic workflow of various cardiac diseases over the past 10 years and allows for accurate biventricular functional analysis and tissue characterization. Cardiac MRI is now considered the gold standard to assess cardiac tumors, myocarditis, cardiomyopathies, and subclinical coronary heart disease. 11,12 In addition, cardiac MRI has demonstrated feasibility of detecting atrial or ventricular thrombi, 13 aortic atherosclerotic plaques, 14,15 or left atrial enlargement. 16,17 Moreover, cardiac MRI is superior to echocardiography on d...

show abstract

Section: Discussionmentioning

confidence: 99%

Feasibility and Diagnostic Value of Cardiovascular Magnetic Resonance Imaging After Acute Ischemic Stroke of Undetermined Origin

Hæusler

Wollboldt

Bentheim

et al. 2017

Stroke

View full text Add to dashboard Cite

show abstract

“…Although cardioembolic strokes have been traditionally associated with AF, recent evidence suggests that AF is not a prerequisite for strokes to occur. 26 There is a clear lack of temporal relationship between episodes of paroxysmal AF and incident stroke. 27 Indeed, atrial electric dysfunction or mechanical dysfunction from fibrosis can increase the risk of stroke in the absence of AF.…”

Section: Discussionmentioning

confidence: 99%

P-Wave Indices and Risk of Ischemic Stroke

Tse

Korantzopoulos

et al. 2017

Stroke

Self Cite

110

View full text Add to dashboard Cite

Background and Purpose-Atrial cardiomyopathy is associated with an increased risk of ischemic stroke. P-wave terminal force in lead V 1 , P-wave duration, and maximum P-wave area are electrocardiographic parameters that have been used to assess left atrial abnormalities related to developing atrial fibrillation. The aim of this systematic review and metaanalysis was to examine their values for predicting ischemic stroke risk. Methods-PubMed and EMBASE databases were searched until December 2016 for studies that evaluated the association between P-wave indices and stroke risk. Both fixed-and random-effects models were used to calculate the overall effect estimates. Results-Ten studies examining P-wave terminal force in lead V 1 , P-wave duration, and maximum P-wave area were included. P-wave terminal force in lead V 1 was found to be an independent predictor of stroke as both a continuous Key Words: atrial fibrillation ◼ electrocardiography ◼ heart atria ◼ odds ratio ◼ stroke P-Wave Indices and Risk of Ischemic Stroke

show abstract

“…Although black persons less often manifest AF, they have a significantly higher prevalence of other electrocardiographic signs of left atrial abnormality 4. This suggests that some of the observed racial disparities in stroke rates may be explained by cases of left atrial thromboembolism that currently go unrecognized because they occur in the absence of AF 27. Further research appears justified to explore the relationship among atrial abnormalities, thromboembolic risk, and racial disparities in stroke rates.…”

Section: Discussionmentioning

confidence: 99%

Rates of Atrial Fibrillation in Black Versus White Patients With Pacemakers

Kamel

Kleindorfer

Bhave

et al. 2016

JAHA

Self Cite

View full text Add to dashboard Cite

BackgroundBlack US residents experience higher rates of ischemic stroke than white residents but have lower rates of clinically apparent atrial fibrillation (AF), a strong risk factor for stroke. It is unclear whether black persons truly have less AF or simply more undiagnosed AF.Methods and ResultsWe obtained administrative claims data from state health agencies regarding all emergency department visits and hospitalizations in California, Florida, and New York. We identified a cohort of patients with pacemakers, the regular interrogation of which reduces the likelihood of undiagnosed AF. We compared rates of documented AF or atrial flutter at follow‐up visits using Kaplan–Meier survival statistics and Cox proportional hazards models adjusted for demographic characteristics and vascular risk factors. We identified 10 393 black and 91 380 white patients without documented AF or atrial flutter before or at the index visit for pacemaker implantation. During 3.7 (±1.8) years of follow‐up, black patients had a significantly lower rate of AF (21.4%; 95% CI 19.8–23.2) than white patients (25.5%; 95% CI 24.9–26.0). After adjustment for demographic characteristics and comorbidities, black patients had a lower hazard of AF (hazard ratio 0.91; 95% CI 0.86–0.96), a higher hazard of atrial flutter (hazard ratio 1.29; 95% CI 1.11–1.49), and a lower hazard of the composite of AF or atrial flutter (hazard ratio 0.94; 95% CI 0.88–99).ConclusionsIn a population‐based sample of patients with pacemakers, black patients had a lower rate of AF compared with white patients. These findings indicate that the persistent racial disparities in rates of ischemic stroke are likely to be related to factors other than undiagnosed AF.

show abstract

Atrial Cardiopathy: A Broadened Concept of Left Atrial Thromboembolism Beyond Atrial Fibrillation

Cited by 144 publications

References 60 publications

Feasibility and Diagnostic Value of Cardiovascular Magnetic Resonance Imaging After Acute Ischemic Stroke of Undetermined Origin

Feasibility and Diagnostic Value of Cardiovascular Magnetic Resonance Imaging After Acute Ischemic Stroke of Undetermined Origin

P-Wave Indices and Risk of Ischemic Stroke

Rates of Atrial Fibrillation in Black Versus White Patients With Pacemakers

Contact Info

Product

Resources

About