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LEFT ATRIAL VOLUME AND GLOBAL LONGITUDINAL PEAK STRAIN TO PREDICT ATRIAL FIBRILLATION IN ISCHEMIC STROKE
LEFT ATRIAL VOLUME AND GLOBAL LONGITUDINAL PEAK STRAIN TO PREDICT ATRIAL FIBRILLATION IN ISCHEMIC STROKE
Abstract
Background and Aims
Recent trials have failed to show the superiority of direct oral anticoagulant (DOAC) agents over antiplatelet agents in patients with embolic stroke of undetermined source (ESUS). Detecting atrial fibrillation (AF) is crucial to prevent recurrence in ischemic stroke patients. We aimed to examine the relation between left atrial volume index (LAVI) and the global longitudinal peak strain (GLPS) with AF in ischemic stroke patients.
Methods
We prospectively included 678 consecutive patients with ischemic stroke. LAVI and GLPS were assessed using three-dimensional transthoracic echocardiography with speckle-tracking imaging. Logistic regression analysis was used to examine the independent association between LAVI, GLPS, and AF. To evaluate the predictability 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 years (mean, standard deviation 13; male, 60%). Patients with AF (18%) were older (75 vs. 66 years, P < 0.001) and had a higher LAVI (42ml/m2 vs. 75 ml/m2, P < 0.001) and higher GLPS than those without AF (-14.0 vs. -17.3, P < 0.001). For 89 patients classified with ESUS, the ESUS AF group had higher GLPS (n = 12, -15.6 vs. -18.3, respectively; P = 0.002) than the other groups (n = 77). Adding GLPS to age, hypertension and the LAVI significantly improved NRI, with an overall NRI improvement of 6.1 % (P = 0.03).
Conclusions
The LAVI and GLPS with speckle-tracking imaging echocardiography may be helpful in discriminating patients with AF.