Journal of Cardiovascular Imaging

Korean Society of Echocardiography (한국심초음파학회)
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Incremental Value of Left Atrial Global Longitudinal Strain for Prediction of Post Stroke Atrial Fibrillation in Patients with Acute Ischemic Stroke

  • Kim, Darae (Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Shim, Chi Young (Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Cho, In Jeong (Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Kim, Young Dae (Department of Neurology, Yonsei University College of Medicine) ;
  • Nam, Hyo Suk (Department of Neurology, Yonsei University College of Medicine) ;
  • Chang, Hyuk-Jae (Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Hong, Geu-Ru (Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Ha, Jong-Won (Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Heo, Ji Hoe (Department of Neurology, Yonsei University College of Medicine) ;
  • Chung, Namsik (Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine)
  • Received : 2015.11.12
  • Accepted : 2016.02.01
  • Published : 2016.03.27
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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 $67{\pm}12$) 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 $CHA_2DS_2$-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 $CHA_2DS_2$-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 $CHA_2DS_2$-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 $CHA_2DS_2$-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.

Keywords

Acknowledgement

Supported by : Korean Society of Echocardiography

References

  1. Hannon N, Sheehan O, Kelly L, Marnane M, Merwick A, Moore A, Kyne L, Duggan J, Moroney J, McCormack PM, Daly L, Fitz-Simon N, Harris D, Horgan G, Williams EB, Furie KL, Kelly PJ. Stroke associated with atrial fibrillation--incidence and early outcomes in the north Dublin population stroke study. Cerebrovasc Dis 2010;29:43-9. https://doi.org/10.1159/000255973
  2. Vingerhoets F, Bogousslavsky J, Regli F, Van Melle G. Atrial fibrillation after acute stroke. Stroke 1993;24:26-30. https://doi.org/10.1161/01.STR.24.1.26
  3. Sposato LA, Klein FR, Jauregui A, Ferrua M, Klin P, Zamora R, Riccio PM, Rabinstein A. Newly diagnosed atrial fibrillation after acute ischemic stroke and transient ischemic attack: importance of immediate and prolonged continuous cardiac monitoring. J Stroke Cerebrovasc Dis 2012;21:210-6. https://doi.org/10.1016/j.jstrokecerebrovasdis.2010.06.010
  4. Schneider C, Malisius R, Krause K, Lampe F, Bahlmann E, Boczor S, Antz M, Ernst S, Kuck KH. Strain rate imaging for functional quantification of the left atrium: atrial deformation predicts the maintenance of sinus rhythm after catheter ablation of atrial fibrillation. Eur Heart J 2008;29:1397-409. https://doi.org/10.1093/eurheartj/ehn168
  5. Sposato LA, Riccio PM, Hachinski V. Poststroke atrial fibrillation: cause or consequence? Critical review of current views. Neurology 2014;82:1180-6. https://doi.org/10.1212/WNL.0000000000000265
  6. Kuppahally SS, Akoum N, Burgon NS, Badger TJ, Kholmovski EG, Vijayakumar S, Rao SN, Blauer J, Fish EN, Dibella EV, Macleod RS, McGann C, Litwin SE, Marrouche NF. Left atrial strain and strain rate in patients with paroxysmal and persistent atrial fibrillation: relationship to left atrial structural remodeling detected by delayed-enhancement MRI. Circ Cardiovasc Imaging 2010;3:231-9. https://doi.org/10.1161/CIRCIMAGING.109.865683
  7. Benito B, Gay-Jordi G, Serrano-Mollar A, Guasch E, Shi Y, Tardif JC, Brugada J, Nattel S, Mont L. Cardiac arrhythmogenic remodeling in a rat model of long-term intensive exercise training. Circulation 2011;123:13-22. https://doi.org/10.1161/CIRCULATIONAHA.110.938282
  8. Mattle HP. Long-term outcome after stroke due to atrial fibrillation. Cerebrovasc Dis 2003;16 Suppl 1:3-8. https://doi.org/10.1159/000069934
  9. Francis DA, Heron JR, Clarke M. Ambulatory electrocardiographic monitoring in patients with transient focal cerebral ischaemia. J Neurol Neurosurg Psychiatry 1984;47:256-9. https://doi.org/10.1136/jnnp.47.3.256
  10. Kessler DK, Kessler KM. Is ambulatory electrocardiography useful in the evaluation of patients with recent stroke? Chest 1995;107:916-8. https://doi.org/10.1378/chest.107.4.916
  11. Jabaudon D, Sztajzel J, Sievert K, Landis T, Sztajzel R. Usefulness of ambulatory 7-day ECG monitoring for the detection of atrial fibrillation and flutter after acute stroke and transient ischemic attack. Stroke 2004;35:1647-51. https://doi.org/10.1161/01.STR.0000131269.69502.d9
  12. Sposato LA, Cipriano LE, Saposnik G, Ruiz Vargas E, Riccio PM, Hachinski V. Diagnosis of atrial fibrillation after stroke and transient ischaemic attack: a systematic review and meta-analysis. Lancet Neurol 2015;14:377-87. https://doi.org/10.1016/S1474-4422(15)70027-X
  13. Vianna-Pinton R, Moreno CA, Baxter CM, Lee KS, Tsang TS, Appleton CP. Two-dimensional speckle-tracking echocardiography of the left atrium: feasibility and regional contraction and relaxation differences in normal subjects. J Am Soc Echocardiogr 2009;22:299-305. https://doi.org/10.1016/j.echo.2008.12.017
  14. Sarvari SI, Haugaa KH, Stokke TM, Ansari HZ, Leren IS, Hegbom F, Smiseth OA, Edvardsen T. Strain echocardiographic assessment of left atrial function predicts recurrence of atrial fibrillation. Eur Heart J Cardiovasc Imaging 2015 Jul 27 [Epub]. http://dx.doi.org/10.1093/ehjci/jev185.
  15. Cameli M, Lisi M, Righini FM, Massoni A, Natali BM, Focardi M, Tacchini D, Geyer A, Curci V, Di Tommaso C, Lisi G, Maccherini M, Chiavarelli M, Massetti M, Tanganelli P, Mondillo S. Usefulness of atrial deformation analysis to predict left atrial fibrosis and endocardial thickness in patients undergoing mitral valve operations for severe mitral regurgitation secondary to mitral valve prolapse. Am J Cardiol 2013;111:595-601. https://doi.org/10.1016/j.amjcard.2012.10.049
  16. Habibi M, Lima JA, Khurram IM, Zimmerman SL, Zipunnikov V, Fukumoto K, Spragg D, Ashikaga H, Rickard J, Marine JE, Calkins H, Nazarian S. Association of left atrial function and left atrial enhancement in patients with atrial fibrillation: cardiac magnetic resonance study. Circ Cardiovasc Imaging 2015;8:e002769. https://doi.org/10.1161/CIRCIMAGING.114.002769
  17. Shaikh AY, Maan A, Khan UA, Aurigemma GP, Hill JC, Kane JL, Tighe DA, Mick E, McManus DD. Speckle echocardiographic left atrial strain and stiffness index as predictors of maintenance of sinus rhythm after cardioversion for atrial fibrillation: a prospective study. Cardiovasc Ultrasound 2012;10:48. https://doi.org/10.1186/1476-7120-10-48
  18. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE 3rd. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993;24:35-41. https://doi.org/10.1161/01.STR.24.1.35
  19. Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest 2010;137:263-72. https://doi.org/10.1378/chest.09-1584
  20. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ; Chamber Quantification Writing Group; American Society of Echocardiography's Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005;18:1440-63. https://doi.org/10.1016/j.echo.2005.10.005
  21. Obokata M, Negishi K, Kurosawa K, Tateno R, Tange S, Arai M, Amano M, Kurabayashi M. Left atrial strain provides incremental value for embolism risk stratification over $CHA_2DS_2-VASc$ score and indicates prognostic impact in patients with atrial fibrillation. J Am Soc Echocardiogr 2014;27:709-16.e4. https://doi.org/10.1016/j.echo.2014.03.010
  22. Shih JY, Tsai WC, Huang YY, Liu YW, Lin CC, Huang YS, Tsai LM, Lin LJ. Association of decreased left atrial strain and strain rate with stroke in chronic atrial fibrillation. J Am Soc Echocardiogr 2011;24:513-9. https://doi.org/10.1016/j.echo.2011.01.016
  23. Transesophageal echocardiography in atrial fibrillation: standards for acquisition and interpretation and assessment of interobserver variability. Stroke Prevention in Atrial Fibrillation Investigators Committee on Echocardiography. J Am Soc Echocardiogr 1996;9:556-66.
  24. Manning WJ, Weintraub RM, Waksmonski CA, Haering JM, Rooney PS, Maslow AD, Johnson RG, Douglas PS. Accuracy of transesophageal echocardiography for identifying left atrial thrombi. A prospective, intraoperative study. Ann Intern Med 1995;123:817-22. https://doi.org/10.7326/0003-4819-123-11-199512010-00001
  25. Beppu S, Nimura Y, Sakakibara H, Nagata S, Park YD, Izumi S. Smoke-like echo in the left atrial cavity in mitral valve disease: its features and significance. J Am Coll Cardiol 1985;6:744-9. https://doi.org/10.1016/S0735-1097(85)80476-9
  26. Vincelj J, Sokol I, Jaksic O. Prevalence and clinical significance of left atrial spontaneous echo contrast detected by transesophageal echocardiography. Echocardiography 2002;19:319-24. https://doi.org/10.1046/j.1540-8175.2002.00319.x
  27. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988;44:837-45. https://doi.org/10.2307/2531595
  28. Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. EAFT (European Atrial Fibrillation Trial) Study Group. Lancet 1993;342:1255-62.
  29. Fauchier L, Clementy N, Pelade C, Collignon C, Nicolle E, Lip GY. Patients wth ischemic stroke and incident atrial fibrillation: a nationwide cohort study. Stroke 2015;46:2432-7. https://doi.org/10.1161/STROKEAHA.115.010270
  30. Benjamin EJ, Levy D, Vaziri SM, D'Agostino RB, Belanger AJ, Wolf PA. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA 1994;271:840-4. https://doi.org/10.1001/jama.1994.03510350050036
  31. Psaty BM, Manolio TA, Kuller LH, Kronmal RA, Cushman M, Fried LP, White R, Furberg CD, Rautaharju PM. Incidence of and risk factors for atrial fibrillation in older adults. Circulation 1997;96:2455-61. https://doi.org/10.1161/01.CIR.96.7.2455
  32. Huxley RR, Filion KB, Konety S, Alonso A. Meta-analysis of cohort and case-control studies of type 2 diabetes mellitus and risk of atrial fibrillation. Am J Cardiol 2011;108:56-62. https://doi.org/10.1016/j.amjcard.2011.03.004
  33. Schnabel RB, Sullivan LM, Levy D, Pencina MJ, Massaro JM, D'Agostino RB Sr, Newton-Cheh C, Yamamoto JF, Magnani JW, Tadros TM, Kannel WB, Wang TJ, Ellinor PT, Wolf PA, Vasan RS, Benjamin EJ. Development of a risk score for atrial fibrillation (Framingham Heart Study): a community-based cohort study. Lancet 2009;373:739-45. https://doi.org/10.1016/S0140-6736(09)60443-8
  34. Hammerstingl C, Schwekendiek M, Momcilovic D, Schueler R, Sinning JM, Schrickel JW, Mittmann-Braun E, Nickenig G, Lickfett L. Left atrial deformation imaging with ultrasound based two-dimensional speckle-tracking predicts the rate of recurrence of paroxysmal and persistent atrial fibrillation after successful ablation procedures. J Cardiovasc Electrophysiol 2012;23:247-55. https://doi.org/10.1111/j.1540-8167.2011.02177.x
  35. Yasuda R, Murata M, Roberts R, Tokuda H, Minakata Y, Suzuki K, Tsuruta H, Kimura T, Nishiyama N, Fukumoto K, Aizawa Y, Tanimoto K, Takatsuki S, Abe T, Fukuda K. Left atrial strain is a powerful predictor of atrial fibrillation recurrence after catheter ablation: study of a heterogeneous population with sinus rhythm or atrial fibrillation. Eur Heart J Cardiovasc Imaging 2015;16:1008-14.
  36. Tops LF, Delgado V, Bertini M, Marsan NA, Den Uijl DW, Trines SA, Zeppenfeld K, Holman E, Schalij MJ, Bax JJ. Left atrial strain predicts reverse remodeling after catheter ablation for atrial fibrillation. J Am Coll Cardiol 2011;57:324-31. https://doi.org/10.1016/j.jacc.2010.05.063
  37. Cameli M, Caputo M, Mondillo S, Ballo P, Palmerini E, Lisi M, Marino E, Galderisi M. Feasibility and reference values of left atrial longitudinal strain imaging by two-dimensional speckle tracking. Cardiovasc Ultrasound 2009;7:6. https://doi.org/10.1186/1476-7120-7-6
  38. Kim DG, Lee KJ, Lee S, Jeong SY, Lee YS, Choi YJ, Yoon HS, Kim JH, Jeong KT, Park SC, Park M. Feasibility of two-dimensional global longitudinal strain and strain rate imaging for the assessment of left atrial function: a study in subjects with a low probability of cardiovascular disease and normal exercise capacity. Echocardiography 2009;26:1179-87. https://doi.org/10.1111/j.1540-8175.2009.00955.x
  39. Verdejo HE, Becerra E, Zalaquet R, Del Campo A, Garcia L, Troncoso R, Chiong M, Marin A, Castro PF, Lavandero S, Gabrielli L, Corbalan R. Atrial function assessed by speckle tracking echocardiography is a good predictor of postoperative atrial fibrillation in elderly patients. Echocardiography 2016;33:242-8. https://doi.org/10.1111/echo.13059

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