title: Predicting Paroxysmal Atrial Fibrillation in Cerebrovascular Ischemia Using Tissue Doppler Imaging and Speckle Tracking Echocardiography.
abstract: BACKGROUND
  Often the underlying cause of cerebral ischemia (CI) cannot be found during a routine diagnostic investigation, but paroxysmal atrial fibrillation (PAF) could be the culprit.
  
  
  OBJECTIVE
  The objective of the study is to investigate whether advanced echocardiography improves the diagnostic approach for PAF in CI.
  
  
  METHODS
  The study included 286 CI patients with an echocardiogram in sinus rhythm. Patients were divided by PAF occurrence (PAF: n = 86, non-PAF: n = 200). PAF was defined as 1 or more reported episodes of atrial fibrillation. Echocardiograms consisted of conventional measures, tissue Doppler imaging (TDI), and speckle tracking. TDI was performed to acquire myocardial peak velocities during systole/ventricular contraction (global s'), early diastole/ventricular filling (global e'), and late diastole/atrial contraction (global a'). Speckle tracking was performed for myocardial strain analysis, thereby retrieving global longitudinal strain and global strain rate (s, e, a) values.
  
  
  RESULTS
  Patients with PAF exhibited significantly impaired atrial contractile measures: global a' (-7.0 cm/second versus -5.7 cm/second, P < .001) and global strain rate a (.97 second(-1) versus .81 second(-1), P < .001). Both were univariable markers of PAF, and along with age remained the only independent significant determinants of PAF after multivariable logistic regression. Area under the curve (AUC) for age, global a', and global strain rate a significantly exceeded AUC for age alone (.79 versus .76, P = .032). Cutoff values with the highest sensitivity and specificity for these 3 parameters improved the diagnostic accuracy (sensitivity = 97%, specificity = 32%, negative predictive value = 95%, and positive predictive value = 38%).
  
  
  CONCLUSIONS
  Atrial contractile measures by advanced echocardiography are significant determinants of PAF in CI. However, there is no discriminatory power to make them clinically useful at the current moment.
authors.affiliation: Department of Cardiology, Herlev Gentofte Hospital, University of Copenhagen, Denmark. Electronic address: flemming.j.olsen@gmail.com.
authors.forename: Flemming Javier
authors.initials: FJ
authors.lastname: Olsen
authors.affiliation: Department of Cardiology, Herlev Gentofte Hospital, University of Copenhagen, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Peter Godsk
authors.initials: PG
authors.lastname: Jørgensen
authors.affiliation: Department of Cardiology, Herlev Gentofte Hospital, University of Copenhagen, Denmark.
authors.forename: Rasmus
authors.initials: R
authors.lastname: Møgelvang
authors.affiliation: Department of Cardiology, Herlev Gentofte Hospital, University of Copenhagen, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jan Skov
authors.initials: JS
authors.lastname: Jensen
authors.affiliation: Department of Cardiology, Herlev Gentofte Hospital, University of Copenhagen, Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Fritz-Hansen
authors.affiliation: Department of Cardiology, Herlev Gentofte Hospital, University of Copenhagen, Denmark.
authors.forename: Jan
authors.initials: J
authors.lastname: Bech
authors.affiliation: Department of Cardiology, Herlev Gentofte Hospital, University of Copenhagen, Denmark; Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Tor
authors.initials: T
authors.lastname: Biering-Sørensen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging*; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging*; D015150:Echocardiography, Doppler; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Ischemic stroke; atrial fibrillation; cardioembolic stroke; echocardiography; speckle tracking; tissue Doppler imaging