J Cardiovasc Ultrasound.  2016 Mar;24(1):20-27. 10.4250/jcu.2016.24.1.20.

Incremental Value of Left Atrial Global Longitudinal Strain for Prediction of Post Stroke Atrial Fibrillation in Patients with Acute Ischemic Stroke

• Kim D
• Shim CY
• Cho IJ
• Kim YD
• Nam HS
• Chang HJ
• Hong GR
• Ha JW
• Heo JH
• Chung N

• KMID: 2160991
• DOI: http://doi.org/10.4250/jcu.2016.24.1.20

Abstract

BACKGROUND
Atrial fibrillation (AF) is a well-established risk factor for stroke. Interestingly, ischemic stroke increases risk of incident AF in patients without prior diagnosed AF. For better risk stratification for post-stroke AF, we studied left atrial (LA) size and mechanical function using two-dimensional (2D) speckle tracking imaging in patients with acute ischemic stroke.
METHODS
A total of 227 patients (132 males, age 67 ± 12) with acute ischemic stroke without a history of AF underwent 2D transthoracic echocardiography and speckle tracking imaging for the assessment of LA volume index and global LA longitudinal strain (LALS). From clinical variables, the CHA2DS2-VASc score and National Institute of Health Stroke Scale (NIHSS) were calculated in each patient. Post-stroke AF was defined as newly diagnosed AF during the course after ischemic stroke.
RESULTS
Post-stroke AF occurred in 25 patients (11%). Patients with post-stroke AF were older and showed a higher tendency of CHA2DS2-VASc score, significantly higher log NIHSS, larger LA volume index and lower global LALS than those without. In multivariate analysis, global LALS was an independent predictor for post-stroke AF (hazard ratio 0.90, 95% confidence interval 0.83.0.97, p < 0.01) after controlling for confounding factors. Furthermore, global LALS provided incremental predictive value for post-stroke AF over the CHA2DS2-VASc score, NIHSS, and LA volume index. The global LALS < 14.5% better distinguished post-stroke AF (area under the curve 0.837, sensitivity 60%, specificity 95%, p < 0.01) than CHA2DS2-VASc score.
CONCLUSION
Global LALS as a marker of LA mechanical function has incremental predictive value for post-stroke AF in patients with acute ischemic stroke.

Keyword

Atrial fibrillation; Stroke; Left atrium; Strain

MeSH Terms

Atrial Fibrillation*
Echocardiography
Heart Atria
Humans
Male
Multivariate Analysis
Risk Factors
Sensitivity and Specificity
Stroke*

Figure

• 

  Fig. 1 Diagnostic performances of global LALS and CHA2DS2-VASc score for post stroke AF. LALS: left atrial longitudinal strain, AF: atrial fibrillation.

• 

  Fig. 2 Incremental value of global LALS for diagnosis of post stroke AF. The addition of LALS to the model on the basis of CHA2DS2-VASc score, log NIHSS, and LAVI resulted in significant improvement in the diagnostic value for stroke. LALS: left atrial longitudinal strain, AF: atrial fibrillation, NIHSS: National Institute of Health Stroke Scale, LAVI: left atrial volume index.

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