Atrial strain and occult atrial fibrillation in cryptogenic stroke patients: a systematic review and meta-analysis

Clin Res Cardiol. 2023 Nov;112(11):1600-1609. doi: 10.1007/s00392-023-02218-z. Epub 2023 May 8.

Abstract

Background: Cryptogenic stroke (CS) remains a significant cause of morbidity. Failure to identify the underlying pathology increases the rate of recurrence. Atrial fibrillation (AF) seems to be responsible for a substantial proportion of CS. Thus, there is an unmet need to identify and properly treat those with silent AF.

Purpose: To investigate the association between left atrial strain and newly diagnosed AF in CS patients.

Objectives: We searched major electronic databases for articles assessing the relationship between either peak left atrial longitudinal (PALS) or peak contractile (PACS) strain-quantified using speckle tracking echocardiography-and the incidence of occult AF during the diagnostic work-up of CS patients.

Results: Eleven studies (two thousand and eighty-one patients) were analyzed. Incidence of occult AF was 19%. Both PALS and PACS were significantly lower in patients with newly diagnosed AF (MD - 8.6%, 95%CI - 10.7 to - 6.4, I2 86.4% and MD - 5.5, 95%CI - 6.8 to - 4.2, I2 80.8%). According to the diagnostic accuracy meta-analysis, PALS < 20% present 71% (95%CI 47-87%) sensitivity and 71% (95%CI 60-81%) specificity for the diagnosis of occult AF, assuming a prevalence of 20%. The corresponding values for PACS < 11% are 83% (95%CI 57-94%) and 78% (95%CI 56-91%).

Conclusion: Both PALS and PACS are significantly lower in patients with CS and silent AF. It seems that the cut-off values mentioned above could help physicians in identifying patients who may benefit more from prolonged rhythm monitoring. More studies are needed to confirm these findings.

Keywords: Atrial fibrillation; Diagnosis; Echocardiography; Strain; Stroke.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Atrial Fibrillation* / diagnosis
  • Atrial Fibrillation* / epidemiology
  • Atrial Fibrillation* / etiology
  • Echocardiography
  • Heart Atria / diagnostic imaging
  • Humans
  • Ischemic Stroke*
  • Stroke* / epidemiology
  • Stroke* / etiology