LA strain helps identifying the cardioembolic etiology of transient ischemic attacks

Abstract

Background Patients who have transient ischemic attacks (TIA) often suffer from asymptomatic and paroxysmal atrial fibrillation (AF). Due to the fact that AF is located in the atria, we sought to determine whether abnormalities in left atrial (LA) structure and function could help identify the cardioembolic cause of TIA in patients with sinus rhythm but with documented episodes of paroxysmal AF. Methods The research included 190 individuals with TIA and classified them into two groups based on the presence (group I) or absence (group II) of confirmed paroxysmal AF. The diagnosis of paroxysmal AF was established by an assessment of medical records. To prevent assessing atrial stunning, cardiac ultrasonography was conducted in sinus rhythm at least 14 days following the initiation the TIA. Results The results indicated that patients in group I were older, more often female, had a history of stroke or TIA, and had a higher CHA2DS2-VASc score. Additionally, they exhibited increased LA volumes, a decreased LA emptying fraction, and markedly altered LA deformation patterns. Three factors were found as being independently associated with paroxysmal AF using multivariate logistic regression: age, LA reservoir strain, and LA emptying fraction (P<0.0001). The variables had as cut-off values: age >55 years, LA reservoir strain<−17%, and LA emptying fraction <51%. Conclusion The current research establishes that LA strains are independently associated with paroxysmal AF in patients with TIA and may aid in determining the cardioembolic origin of these events. Our findings have considerable clinical implications because, until now, LA 2D-STE was not included in the usual evaluation of TIA patients, but it may be the ideal next step in this regard. Funding Acknowledgement Type of funding sources: None.

ESC Congress 2022 Imaging Highlights

“…Atrial strain and 3D calculated volume have been shown to predict the development of AF, stroke and even heart failure in different scenarios, such as after a cerebrovascular event, after coronary artery bypass grafting and in dilated cardiomyopathy or hypertrophic cardiomyopathy. [22][23][24][25][26] In addition, atrial strain has shown prognostic value in a number of interventions, such as percutaneous mitral valve repair or aortic valve replacement. 6,22,26,27 The discovery of new therapies and the pathophysiological insights presented by numerous studies increasingly guide the need for the translation of cardiac imaging technology from research interests towards established measures of clinical practice, with a direct impact on our final objective: to provide the best possible care for our patients.…”

“…[22][23][24][25][26] In addition, atrial strain has shown prognostic value in a number of interventions, such as percutaneous mitral valve repair or aortic valve replacement. 6,22,26,27 The discovery of new therapies and the pathophysiological insights presented by numerous studies increasingly guide the need for the translation of cardiac imaging technology from research interests towards established measures of clinical practice, with a direct impact on our final objective: to provide the best possible care for our patients.…”

“…Atrial strain and 3D calculated volume have been shown to predict the development of AF, stroke and even heart failure in different scenarios, such as after a cerebrovascular event, after coronary artery bypass grafting and in dilated cardiomyopathy or hypertrophic cardiomyopathy. [ 22 – 26 ] In addition, atrial strain has shown prognostic value in a number of interventions, such as percutaneous mitral valve repair or aortic valve replacement. [ 6 , 22 , 26 , 27 ]…”

“…[ 22 – 26 ] In addition, atrial strain has shown prognostic value in a number of interventions, such as percutaneous mitral valve repair or aortic valve replacement. [ 6 , 22 , 26 , 27 ]…”