title: Transthoracic echocardiography to rule out paroxysmal atrial fibrillation as a cause of stroke or transient ischemic attack.
abstract: OBJECTIVE
  We assessed whether echocardiography can predict paroxysmal atrial fibrillation (PAF) in patients with cerebral ischemia presenting in sinus rhythm.
  
  
  METHODS
  Within the prospective Find-AF cohort, 193 consecutive patients with cerebral ischemia and sinus rhythm on presentation had evaluation of echocardiographic parameters of left atrial size and function. PAF was diagnosed by 7-day Holter monitoring.
  
  
  RESULTS
  In 26 patients with PAF, late diastolic Doppler (A) and tissue Doppler (a') velocities were lower whereas left atrial diameter, left atrial volume index (LAVI), LAVI/A, and LAVI/a' were larger (P<0.05 for all) than they were in 167 patients without PAF. In multivariate models A, a', LAVI/A, and LAVI/a' predicted the presence of PAF. Area under the receiver operating characteristic curve to diagnose PAF was highest for LAVI/a' (0.813 [0.738; 0.889]). A previously suggested cut-off of LAVI/a'<2.3 had 92% sensitivity, 55.8% specificity, and 98% negative predictive value for PAF.
  
  
  CONCLUSIONS
  LAVI/a'<2.3 can effectively rule out PAF in patients with cerebral ischemia.
authors: Department of Cardiology and Pneumology, University of Göttingen, Göttingen, Germany.
authors: Raoul
authors: R
authors: Stahrenberg
authors: Frank
authors: F
authors: Edelmann
authors: Beatrice
authors: B
authors: Haase
authors: Rosine
authors: R
authors: Lahno
authors: Jochen
authors: J
authors: Seegers
authors: Mark
authors: M
authors: Weber-Krüger
authors: Meinhard
authors: M
authors: Mende
authors: Janin
authors: J
authors: Wohlfahrt
authors: Pawel
authors: P
authors: Kermer
authors: Dirk
authors: D
authors: Vollmann
authors: Gerd
authors: G
authors: Hasenfuss
authors: Klaus
authors: K
authors: Gröschel
authors: Rolf
authors: R
authors: Wachter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology