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. 2022 Apr 25:9:869076.
doi: 10.3389/fcvm.2022.869076. eCollection 2022.

Predictive Value of Left Atrial and Ventricular Strain for the Detection of Atrial Fibrillation in Patients With Cryptogenic Stroke

Gabriella Bufano  1 , Francesco Radico  2 , Carolina D'Angelo  2 , Francesca Pierfelice  1 , Maria Vittoria De Angelis  3 , Massimiliano Faustino  4 , Sante Donato Pierdomenico  1 , Sabina Gallina  5 , Giulia Renda  5
Affiliations

Predictive Value of Left Atrial and Ventricular Strain for the Detection of Atrial Fibrillation in Patients With Cryptogenic Stroke

Gabriella Bufano et al. Front Cardiovasc Med. .

Abstract

Background and aims: Cryptogenic stroke (CS) is associated with a high rate of recurrences and adverse outcomes at long-term follow-up, especially due to its unknown etiology that often leads to ineffective secondary prevention. Asymptomatic atrial fibrillation (AF) could play an important pathophysiological role. Some studies have pointed to left atrial (LA) and left ventricular (LV) systolic and diastolic dysfunction as surrogate markers of AF. The aim of the study is to evaluate the relationship between echocardiographic parameters of LA and LV function, and the occurrence of AF revealed by continuous ECG monitoring in a cohort of patients with CS.

Methods: Single-center prospective cohort study. Seventy-two patients with CS with insertable cardiac monitors (ICM) underwent transthoracic echocardiography (TTE). TTE was focused on LA and LV function, including both standard and longitudinal strain-derived parameters. All detected AF episodes lasting more than 2 min were considered.

Results: Continuous ECG monitoring revealed subclinical AF in 23 patients (32%) at an average of 6.5 months after ICM implantation. Many echocardiographic parameters, indicating LA volume and LV systolic/diastolic function, were significantly associated with the occurrence of AF, suggesting the worst atrial function in the AF group. Furthermore, multivariable regression analysis revealed that peak atrial contraction strain and left ventricular strain were independently associated with AF (adjusted OR = 0.72, CI 95% 0.48-0.90, p = 0.005, and adjusted OR = 0.69, CI 95% 0.46-0.95, p = 0.041, respectively).

Conclusion: In patients with CS, LA and LV strain analysis add predictive value for the occurrence of AF over clinical and morpho-functional echocardiographic parameters. Impaired booster pump strain and LV longitudinal strain are strong and independent predictors of AF.

Keywords: atrial fibrillation; atrial myopathy; cryptogenic stroke; insertable cardiac monitor; left atrial strain; left ventricular longitudinal strain.

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Conflict of interest statement

FR: speaker/consultant fee from Boehringer Ingelheim, Daiichi Sankyo. SP: speaker/consultant fee from Astra Zeneca, Bayer. GR: speaker/consultant fee from Astra Zeneca, Bayer, BMS-Pfizer, Boehringer Ingelheim, Daiichi Sankyo. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram with inclusion and exclusion criteria. *According to Trial of Org 10172 in Acute Stroke Treatment's (TOAST's) classification. CS, cryptogenic stroke; ICM, insertable cardiac monitor.
Figure 2
Figure 2
Comparison of left atrial (LA) and left ventricular (LV) strain in patients from atrial fibrillation (AF) group and no-AF group. (A) Shows LA strain of a patient of the AF group. (B) Shows LV strain of the same patient of the AF group. (C) Shows LA strain of a patient of the no-AF group. (D) Shows LV strain of the same patient of the no-AF group.
Figure 3
Figure 3
Receiver-operating characteristic (ROC) curve analysis. Peak Atrial Contractile Strain [PACS, (A)], Left Ventricular Longitudinal Strain [LVLS, (B)], and PACS combined with LVLS (C) for AF prediction. AUC, area under curve.
Figure 4
Figure 4
Kaplan–Meyer estimates of AF probability according to PACS (A), or according to LVLS (B). HR, Hazard Ratio.
See this image and copyright information in PMC

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