title: Diagnosing Paroxysmal Atrial Fibrillation in Patients With Ischemic Strokes and Transient Ischemic Attacks Using Echocardiographic Measurements of Left Atrium Function.
abstract: Twenty-five to 35 percentage of stroke cases are cryptogenic, and it has been demonstrated that paroxysmal atrial fibrillation (AF) is the causal agent in up to 25% of these incidents. The purpose of this study was to investigate if left atrial (LA) parameters have value for diagnosing paroxysmal AF in patients with ischemic stroke (IS) and transient ischemic attack (TIA). We retrospectively analyzed 219 patients who after acute IS or TIA underwent a transthoracic echocardiographic examination. Patients were designated as patients with paroxysmal AF if they had one or more reported incidents of AF before or after their echocardiographic examination. Patients in the paroxysmal AF group were significantly older and had higher CHA2DS2-VASc score than patients without paroxysmal AF (p <0.05 for both). None of the conventional echocardiographic parameters were significantly associated with paroxysmal AF. However, the atrial measurements evaluating LA function (min LA volume and LA emptying fraction) were significantly different (LA emptying fraction: 45% ± 10% vs 50% ± 10%, p = 0.004; minimal LA volume: 30.2 ml ± 17.3 ml vs 24 ml ± 10 ml, p = 0.035 in patients with paroxysmal AF, even after adjustment for age, gender, CHA2DS2-VASc score, and stroke severity [p <0.05 for both]). By combining the cut-off values of age, LA emptying fraction, and minimal LA volume the diagnostic accuracy of paroxysmal AF was improved, resulting in a sensitivity of 95% and negative predictive value of 97%. In conclusion, in patients with IS and TIA, LA function measurements (minimal LA volume and LA emptying fraction) are independently associated with paroxysmal AF and may improve risk stratification for paroxysmal AF presence after IS or TIA.
authors.affiliation: Department of Neurology, Bispebjerg Hospital, University of Copenhagen, Denmark; Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark. Electronic address: kristofferskaarup@hotmail.com.
authors.forename: Kristoffer Grundtvig
authors.initials: KG
authors.lastname: Skaarup
authors.affiliation: Department of Neurology, Bispebjerg Hospital, University of Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark.
authors.forename: Hanne
authors.initials: H
authors.lastname: Christensen
authors.affiliation: Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Denmark.
authors.forename: Nis
authors.initials: N
authors.lastname: Høst
authors.affiliation: Department of Neurology, Bispebjerg Hospital, University of Copenhagen, Denmark.
authors.forename: Masti Mahdy
authors.initials: MM
authors.lastname: Mahmoud
authors.affiliation: Department of Neurology, Bispebjerg Hospital, University of Copenhagen, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Ovesen
authors.affiliation: Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark.
authors.forename: Flemming Javier
authors.initials: FJ
authors.lastname: Olsen
authors.affiliation: Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark.
authors.forename: Tor
authors.initials: T
authors.lastname: Biering-Sørensen
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016279:Atrial Function, Left / Q000502:physiology*; D002545:Brain Ischemia / Q000209:etiology*; D018619:Echocardiography, Doppler, Pulsed / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D013614:Tachycardia, Paroxysmal / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology