Use of Atrial Strain to Predict Atrial Fibrillation After Cerebral Ischemia

Pathan, Faraz; Sivaraj, E.; Negishi, Kazuaki; Rafiudeen, Rifly; Pathan, S.; D’Elia, Nicholas; Galligan, J.; Neilson, Samuel; Fonseca, Ricardo; Marwick, Thomas H.

doi:10.1016/j.jcmg.2017.07.027

Cited by 93 publications

(67 citation statements)

References 28 publications

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“…In a recent retrospective single-center study on 531 cryptogenic stroke patients, low atrial strain as well as global longitudinal strain of the LV showed incremental value for AF risk prediction over LA volume, LV ejection fraction and E/e' ratio [91•]. This is in line with results from another retrospective single-center study on 616 cryptogenic stroke patients [92]. In a recent small prospective single-center study with 56 cryptogenic stroke patients who had a cardiac monitor implanted for AF monitoring, low left atrial strain predicted incident AF independent of classical parameters of diastolic dysfunction, global longitudinal LV strain and cardiovascular risk factors [93].…”

Section: Cardiac Imaging For Atrial Cardiomyopathy and Prediction Of supporting

confidence: 76%

Cardiac Imaging After Ischemic Stroke or Transient Ischemic Attack

Camen

Hæusler

Schnabel

2020

Curr Neurol Neurosci Rep

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Purpose of Review Cardiac imaging after ischemic stroke or transient ischemic attack (TIA) is used to identify potential sources of cardioembolism, to classify stroke etiology leading to changes in secondary stroke prevention, and to detect frequent comorbidities. This article summarizes the latest research on this topic and provides an approach to clinical practice to use cardiac imaging after stroke. Recent Findings Echocardiography remains the primary imaging method for cardiac work-up after stroke. Recent echocardiography studies further demonstrated promising results regarding the prediction of non-permanent atrial fibrillation after ischemic stroke. Cardiac magnetic resonance imaging and computed tomography have been tested for their diagnostic value, in particular in patients with cryptogenic stroke, and can be considered as second line methods, providing complementary information in selected stroke patients. Summary Cardiac imaging after ischemic stroke or TIA reveals a potential causal condition in a subset of patients. Whether systematic application of cardiac imaging improves outcome after stroke remains to be established.

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Section: Cardiac Imaging For Atrial Cardiomyopathy and Prediction Of supporting

confidence: 76%

Cardiac Imaging After Ischemic Stroke or Transient Ischemic Attack

Camen

Hæusler

Schnabel

2020

Curr Neurol Neurosci Rep

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“…In that context, our finding of larger left atrial size among ESUS cases supports the concept of a thrombogenic atrial cardiomyopathy. However, the mean LAVI in our ESUS cases (approximately 33 mL/m 2 ) was within the normal range, indicating that LAVI may not be a very useful discriminator, in which case imaging biomarkers of atrial function such as left atrial strain may help distinguish between myopathic and non‐myopathic atria …”

Section: Discussionmentioning

confidence: 72%

Relationship between left atrial volume and ischemic stroke subtype

Kamel

Okin

Merkler

et al. 2019

Ann Clin Transl Neurol

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Objective Atrial cardiopathy without atrial fibrillation (AF) may be a potential cardiac source of embolic strokes of undetermined source (ESUS). Atrial volume is a feature of atrial cardiopathy, but the relationship between atrial volume and ESUS remains unclear. Methods We compared left atrial volume among ischemic stroke subtypes in the Cornell Acute Stroke Academic Registry (CAESAR), which includes all patients with acute ischemic stroke at our hospital since 2011. Stroke subtype was determined by neurologists per the TOAST classification and consensus ESUS definition. Left atrial volume index (LAVI) was obtained directly from our echocardiography image system (Xcelera, Philips Healthcare). We used t‐tests and analysis of variance for unadjusted comparisons and targeted minimum loss‐based estimation for comparisons adjusted for demographics and comorbidities. Results Among 2116 patients in CAESAR from 2011 to 2016, 1293 had LAVI measurements. LAVI varied across subtypes (P < 0.001) from 48.8 (±30.0) mL/m2 in cardioembolic strokes to 30.3 (±10.5) mL/m2 in small‐vessel strokes. LAVI was larger in ESUS (33.3 ± 13.6 mL/m2) than in small‐ or large‐vessel stroke (30.9 ± 10.7 mL/m2) (P = 0.01). The association between LAVI and ESUS persisted after the adjustment for demographics and comorbidities: a 10 mL/m2 increase in LAVI was associated with a 4.4% increase in ESUS probability (95% CI, 2.3%–6.4%). Results were similar after excluding patients with AF during post‐discharge heart‐rhythm monitoring. Interpretation We found larger left atria among patients with ESUS versus non‐cardioembolic stroke. There was significant overlap in left atrial size between ESUS and non‐cardioembolic stroke, highlighting that many ESUS cases are not cardioembolic.

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“…The e’sr was calculated by averaging the values for peak strain rate during early diastole for the 3 apical views [22,23]. To measure LA strain, with apical 2- and 4-chamber views, the STE software algorithm was applied to the LA wall [13–15]. LA stiffness was calculated as averaged E/e’ divided by LA strain (E/e’/LA strain) [13].…”

Section: Methodsmentioning

confidence: 99%

“…Compared with conventional techniques on echocardiography including tissue Doppler imaging, speckle tracking echocardiography (STE) is more accurate for evaluating subclinical LV dysfunction [10–12]. STE was also reported to enable to assess left atrial (LA) function for detecting various subclinical conditions [13–15]. Few studies have used measures of echocardiographic tissue imaging, including STE-derived strain and strain rate, to assess the association of cardiac function with IVI.…”

Section: Introductionmentioning

confidence: 99%

Transient depression of myocardial function after influenza virus infection: A study of echocardiographic tissue imaging

et al. 2019

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Background Influenza virus infection (IVI) was reported to be associated with minor cardiac changes, mostly those detected on electrocardiogram with and without elevated blood markers of myocardial injury; however, the characteristics of myocardial involvement in association with IVI are poorly understood. This study used echocardiographic tissue imaging (tissue Doppler, strain, and strain rate) to evaluate changes in left atrial (LA) and left ventricular (LV) myocardial function after IVI. Methods and results We examined 20 adult individuals (mean age, 43 years) at 2 and 4 weeks after diagnosis of IVI. For myocardial functional variables, we obtained LV global longitudinal strain (GLS), LV early diastolic strain rate (e'sr), LA strain, and LA stiffness (E/e’/LA strain), in addition to data on tissue Doppler (s’, e’, and a’) and myocardial performance index. Blood markers of myocardial injury were also examined. During follow-up, there were no significant changes in global chamber function such as LV ejection fraction, E/e’, and LA volume. However, significant changes in myocardial function were observed, namely, in s’ (8.0 ± 1.6 cm/s to 9.3 ± 1.5 cm/s; p = 0.01), e’ (10.2 ± 2.8 cm/s to 11.4 ± 3.0 cm/s; p < 0.001), e’sr (1.43 ± 0.44 1/s to 1.59 ± 0.43 1/s; p = 0.005), and LA strain (35 ± 8% to 40 ± 12%; p = 0.025), and the myocardial performance index (0.52 ± 0.20 to 0.38 ± 0.09; p = 0.009), but not in a’, LA stiffness, or GLS. Cardiac troponin T and creatinine kinase isoenzyme MB were not elevated significantly at any examination. Conclusions Myocardial dysfunction during IVI recovery appeared to be transient particularly in the absence of myocardial injury. Echocardiographic tissue imaging may be useful to detect subclinical cardiac changes in association with IVI.

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Use of Atrial Strain to Predict Atrial Fibrillation After Cerebral Ischemia

Abstract: Left atrial strain adds independent and incremental predictive value to current risk-prediction models for AF following cryptogenic CVA. Further studies should examine the implications of these findings for AF monitoring or empiric anticoagulation.

Cited by 93 publications

References 28 publications

Cardiac Imaging After Ischemic Stroke or Transient Ischemic Attack

Cardiac Imaging After Ischemic Stroke or Transient Ischemic Attack

Relationship between left atrial volume and ischemic stroke subtype

Transient depression of myocardial function after influenza virus infection: A study of echocardiographic tissue imaging

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