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. 2024 Jan 5:14:1287609.
doi: 10.3389/fneur.2023.1287609. eCollection 2023.

The usefulness of global longitudinal peak strain and left atrial volume index in predicting atrial fibrillation in patients with ischemic stroke

Soo-Hyun Park  1 , Yerim Kim  1 , Minwoo Lee  2 , Sang-Hwa Lee  3 , Jong Seok Bae  1 , Ju-Hun Lee  1 , Tae Jung Kim  4 , Sang-Bae Ko  4 , Sang-Wuk Jeong  5 , Dong-Eog Kim  5 , Wi-Sun Ryu  5
Affiliations

The usefulness of global longitudinal peak strain and left atrial volume index in predicting atrial fibrillation in patients with ischemic stroke

Soo-Hyun Park et al. Front Neurol. .

Abstract

Introduction: Detection of atrial fibrillation (AF) is crucial for preventing recurrence in patients with ischemic stroke. We aimed to examine whether the left atrial volume index (LAVI) and global longitudinal peak strain (GLPS) are associated with AF in patients with ischemic stroke.

Methods: We prospectively analyzed 678 consecutive patients with ischemic stroke. LAVI and GLPS were assessed using three-dimensional transthoracic echocardiography with speckle-tracking imaging. Multiple logistic regression was used to evaluate the association of AF with LAVI and GLPS. To evaluate the predictive value of LAVI and GLPS for the presence of AF, we used optimism-corrected c-statistics calculated by 100 bootstrap repetitions and the net reclassification improvement (NRI).

Results: The mean patient age was 68 ± 13 years (men, 60%). Patients with AF (18%) were a higher LAVI (41.7 ml/m2 vs. 74.9 ml/m2, P < 0.001) and a higher GLPS than those without AF (-14.0 vs. -17.3, P < 0.001). Among the 89 patients classified with embolic stroke of unknown source, the probable cardioembolic group had higher GLPS (n= 17, -14.6 vs. -18.6, respectively; P= 0.014) than the other groups (n= 72). Adding GLPS to age, hypertension, and the LAVI significantly improved the NRI, with an overall NRI improvement of 6.1% (P= 0.03).

Discussion: The LAVI andGLPS with speckle-tracking imaging echocardiography may help identify patients with AF.

Keywords: atrial fibrillation; embolic stroke of undetermined source; global longitudinal peak strain; ischemic stroke; left atrial volume index; speckle-tracking imaging echocardiography.

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Conflict of interest statement

The 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
Global longitudinal peak strain (GLPS) and left atrial volume index (LAVI) according to causative classification system (CCS) subtype. According to the CCS subtype, the GLPS value (A) and LAVI (B) were the highest for cardioembolism.
Figure 2
Figure 2
The relationship between global longitudinal peak strain (GLPS) and left atrial volume index (LAVI). The scatterplot shows the relationship between LAVI and GLPS. LAVI = 84.06 + 2 X LPS, R2 = 0.146; P < 0.001.
Figure 3
Figure 3
Receiver operating curve analysis with or without global longitudinal peak strain (GLPS). The baseline model includes age, hypertension, and left atrial volume index. The C-index for the model without GLPS (red line) was 0.8938 (95% CI 0.8594–0.9281). The C-index for the model with GLPS (blue line) was 0.9039 (95% CI 0.8717–0.9361, P = 0.028).
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