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Usefulness of left ventricular speckle tracking echocardiography and novel measures of left atrial structure and function in diagnosing paroxysmal atrial fibrillation in ischemic stroke and transient ischemic attack patients

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Abstract

Asymptomatic paroxysmal atrial fibrillation (PAF) is often assumed to be the cause of cryptogenic ischemic strokes (IS) and transient ischemic attacks (TIA). We examined the usefulness of measures obtained by 2D speckle tracking echocardiography and novel left atrial measurements, in the diagnosis of PAF in patients with IS and TIA. We retrospectively included 205 patients who after acute IS or TIA underwent an echocardiogram in sinus rhythm. Patients were designated as PAF-patients if they had one or more reported incidents of AF before or after their echocardiographic examination. None of the conventional echocardiographic parameters were significantly associated with PAF. Of the speckle tracking measurements, only early diastolic strain rate (0.7±0.2 s−1 vs. 0.8±0.3 s−1, p = 0.048) and global longitudinal displacement (GLD) (3.15 ± 1.40 mm vs. 3.87 ± 1.56 mm, p = 0.007) proved significantly different. Of the left atrial parameters both minimal and maximal left atrium volume divided by left ventricular length (min LAV/LVL and max LAV/LVL, respectively) were significantly impaired (min LAV/LVL: 3.7 ± 2.1 cm2 vs. 2.8 ± 1.11 cm2, p = 0.012; max LAV/LVL: 6.6 ± 3.1 cm2 vs. 5.6 ± 1.7 cm2, p = 0.012). GLD, min max LAV/LVL proved significant after adjustment for age, gender, CHA2DS2-VASc and NIHSS. By combining information regarding age, GLD, min and max LAV/LVL the diagnostic accuracy of PAF improved, resulting in a significantly increased area under the curve (p = 0.037). In patients with IS and TIA GLD, min and max LAV/LVL were independently associated with the presence of PAF.

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Authors and Affiliations

  1. Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Post 835, Kildegårdsvej 28, 2900, Copenhagen, Denmark

    Kristoffer Grundtvig Skaarup, Flemming Javier Olsen, Jan Skov Jensen & Tor Biering-Sørensen

  2. Department of Neurology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark

    Kristoffer Grundtvig Skaarup, Hanne Christensen, Masti Mahdy Mahmoud & Christian Ovesen

  3. Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark

    Hanne Christensen & Jan Skov Jensen

  4. Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark

    Nis Høst

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  1. Kristoffer Grundtvig Skaarup
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Correspondence to Kristoffer Grundtvig Skaarup.

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Skaarup, K.G., Christensen, H., Høst, N. et al. Usefulness of left ventricular speckle tracking echocardiography and novel measures of left atrial structure and function in diagnosing paroxysmal atrial fibrillation in ischemic stroke and transient ischemic attack patients. Int J Cardiovasc Imaging 33, 1921–1929 (2017). https://doi.org/10.1007/s10554-017-1204-1

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  • DOI: https://doi.org/10.1007/s10554-017-1204-1

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