Clinical InvestigationsLeft Atrial Appendage Flow and Future Atrial FibrillationReduced Left Atrial Appendage Flow Is Associated With Future Atrial Fibrillation After Cryptogenic Stroke
Central Illustration
The predictive value of LAAev in the occurrence of AF after cryptogenic stroke.
Section snippets
Study Population
Our study cohort included consecutive patients with cryptogenic stroke at Ziekenhuis Oost-Limburg in Belgium between 2017 and 2022. The diagnosis of stroke was based on clinical examination by the attending neurologist and findings on computed tomography or brain magnetic resonance imaging. Patients with transient ischemic attacks were enrolled only if symptoms at presentation were aphasia, limb weakness, or hemianopsia. All patients were admitted to the stroke unit and underwent ≥24 hours of
Patient Characteristics
Among 141 patients with cryptogenic stroke, 31 (22%) were excluded. TEE was unachievable in two patients (1%), and in 29 patients (21%), pulsed-wave Doppler flow LAA interrogation by TEE was lacking. The baseline characteristics of the study population (n = 110) are summarized in Table 1. The mean age was 67 ± 12 years, and the majority were men (52%). The median CHA2DS2-VASc score was 3 (IQR, 2-4), implying a theoretical AF-related stroke risk of >5.9% per year (without anticoagulation).21
Discussion
To the best of our knowledge, this is the first study evaluating LAA peak flow velocity measurements in patients with acute cryptogenic stroke who underwent long-term continuous cardiac rhythm monitoring to detect subclinical AF (Central Illustration). The main findings of this study are as follows: (1) reduced LAAev is strongly and independently associated with future AF occurrence after stroke, and (2) a cutoff value of 55 cm/sec yields sensitivity of 90% and specificity of 76% to unmask
Conclusion
LAA peak flow velocities measured early after cryptogenic stroke can identify patients at high risk for underlying AF, in whom prolonged rhythm monitoring using implantable cardiac monitoring should be considered. This finding may improve the diagnostic accuracy and cost-effectiveness of implantable cardiac monitoring in daily clinical practice.
References (48)
- et al.
Thoracoscopic obliteration of the left atrial appendage: potential for stroke reduction?
Ann Thorac Surg
(1996) - et al.
Left atrial appendage flow velocity as a quantitative surrogate parameter for thromboembolic risk: determinants and relationship to spontaneous echocontrast and thrombus formation–A transesophageal echocardiographic study in 500 patients with cerebral ischemia
J Am Soc Echocardiogr
(2005) - et al.
Echocardiography for left atrial appendage structure and function
Indian Heart J
(2012) Left atrial size and function: role in prognosis
J Am Coll Cardiol
(2014)- et al.
Embolic strokes of undetermined source: the case for a new clinical construct
Lancet Neurol
(2014) - et al.
Multiplane transesophageal echocardiographic assessment of left atrial appendage anatomy and function
Am J Cardiol
(1995) - et al.
Echocardiographic assessment of the left atrial appendage
J Am Coll Cardiol
(1999) - et al.
2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American heart association task force on clinical practice guidelines and the heart rhythm Society
J Am Coll Cardiol
(2019) - et al.
Pathophysiologic correlates of thromboembolism in nonvalvular atrial fibrillation: I. Reduced flow velocity in the left atrial appendage
J Am Soc Echocardiogr
(1999) - et al.
Transesophageal echocardiographic predictors for maintenance of sinus rhythm after electrical cardioversion of atrial fibrillation
Am J Cardiol
(1997)
Transesophageal echocardiographic correlates of clinical risk of thromboembolism in nonvalvular atrial fibrillation
J Am Coll Cardiol
Clinical value of left atrial appendage flow for prediction of long-term sinus rhythm maintenance in patients with nonvalvular atrial fibrillation
J Am Coll Cardiol
Evaluation of left atrial appendage function by measurement of changes in flow velocity patterns after electrical cardioversion in patients with isolated atrial fibrillation
Am J Cardiol
“Stunning” of the left atrium after spontaneous conversion of atrial fibrillation to sinus rhythm: demonstration by transesophageal Doppler techniques in a canine model
J Am Coll Cardiol
Left atrial mechanics assessed early during hospitalization for cryptogenic stroke are associated with occult atrial fibrillation: a speckle-tracking strain echocardiography study
J Am Soc Echocardiogr
Use of atrial strain to predict atrial fibrillation after cerebral ischemia
JACC Cardiovasc Imaging
Diagnostic and prognostic value of left atrial function in identification of cardioembolism and prediction of outcomes in patients with cryptogenic stroke
J Am Soc Echocardiogr
Association of left atrial fibrosis detected by delayed-enhancement magnetic resonance imaging and the risk of stroke in patients with atrial fibrillation
J Am Coll Cardiol
Mitral regurgitation as an independent risk factor for cerebrovascular accident in patients with atrial fibrillation
J Am Coll Cardiol
Left atrial appendage function and stroke risk
Stroke
Cardioembolic stroke
Circ Res
Infarcts of undetermined cause: the NINCDS stroke data bank
Ann Neurol
Stroke risk evaluation for patients with atrial fibrillation: insights from left atrial appendage
Front Cardiovasc Med
Cryptogenic stroke
Circ Res
Cited by (0)
Conflicts of Interest: None.