title: Association between paroxysmal atrial fibrillation and the left atrial appendage ejection fraction during sinus rhythm in the acute stage of stroke: a transesophageal echocardiographic study.
abstract: BACKGROUND
  This study aimed to investigate whether left atrial appendage (LAA) dysfunction evaluated by transesophageal echocardiography (TEE) during sinus rhythm is predictable of paroxysmal atrial fibrillation (PAF) as an embolic source in the acute stage of stroke.
  
  
  RESULTS
  We measured and analyzed LAA flow velocity (LAA-FV) and LAA ejection fraction (LAA-EF) in 300 acute ischemic stroke patients by TEE. We divided the acute ischemic stroke patients into 3 groups. The atrial fibrillation (AF) group (n=58) comprised patients whose TEE was performed during AF rhythm. The PAF group (n=42) comprised patients with a history of AF but with normal sinus rhythm when TEE was performed. The normal sinus (sinus) group (n=200) did not have any history of AF. We found that mean LAA-FV and LAA-EF values in the PAF group were significantly lower than those in the sinus group (P<.001). The diagnostic accuracy of LAA-FV for the diagnosis of PAF calculated as the area under receiver operating characteristic curves was low (.582, 95% confidence interval [CI]=.498-.665) but that of LAA-EF was modest (.721, 95% CI=.653-.789), with an optimal cutoff point of 49.1%.
  
  
  CONCLUSIONS
  LAA dysfunction as determined by TEE (LAA-EF<49.1%) in the acute stage of stroke is predictive of PAF with moderate accuracy. Long-term electrocardiographic monitoring is recommended for cryptogenic stroke patients with LAA dysfunction.
authors.affiliation: Division of Neurology, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan. Electronic address: shimi-taka@marianna-u.ac.jp.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Shimizu
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Takada
authors.forename: Atsuko
authors.initials: A
authors.lastname: Shimode
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Fujita
authors.forename: Noriko
authors.initials: N
authors.lastname: Usuki
authors.forename: Bunta
authors.initials: B
authors.lastname: Kato
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takaishi
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Hirayama
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Hanzawa
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hasegawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001146:Arrhythmia, Sinus / Q000000981:diagnostic imaging / Q000503:physiopathology*; D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*
keywords: Cardioembolic stroke; left atrial appendage; paroxysmal atrial fibrillation; transesophageal echocardiography