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

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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.

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Data availability

Data are available upon reasonable request.

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Acknowledgements

IA, CK, and GG were involved in study conception and design. MK and EL were involved in searching databases and extracting data of interest. IA, NTP, and GG were involved in data analysis and interpretation. IA, MK, NTP, and NS drafted the manuscript. CK, SD, and GG critically revised the drafted version of the manuscript.

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The study was performed without any external support.

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Authors and Affiliations

  1. Cardiology Department, Athens General Hospital “G. Gennimatas”, 154 Mesogion Avenue, 11527, Athens, Greece

    Ioannis Anagnostopoulos, Maria Kousta, Charalampos Kossyvakis & Nikolaos Taxiarchis Paraskevaidis

  2. Department of Cardiothoracic Surgery, Hygeia Hospital, Athens, Greece

    Nikolaos Schizas

  3. 2nd Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece

    Dimitrios Vrachatis & Spyridon Deftereos

  4. 3rd Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Georgios Giannopoulos

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  1. Ioannis Anagnostopoulos
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Anagnostopoulos, I., Kousta, M., Kossyvakis, C. et al. Atrial strain and occult atrial fibrillation in cryptogenic stroke patients: a systematic review and meta-analysis. Clin Res Cardiol 112, 1600–1609 (2023). https://doi.org/10.1007/s00392-023-02218-z

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