The usefulness of global longitudinal peak strain and left atrial volume index in predicting atrial fibrillation in patients with ischemic stroke

Soo-Hyun Park; Yerim Kim; Minwoo Lee; Sang-Hwa Lee; Jong Seok Bae; Ju-Hun Lee; Tae Jung Kim; Sang-Bae Ko; Sang-Wuk Jeong; Dong-Eog Kim; Wi-Sun Ryu

doi:10.3389/fneur.2023.1287609

The usefulness of global longitudinal peak strain and left atrial volume index in predicting atrial fibrillation in patients with ischemic stroke

Front Neurol. 2024 Jan 5:14:1287609. doi: 10.3389/fneur.2023.1287609. eCollection 2023.

Authors

Soo-Hyun Park¹, Yerim Kim¹, Minwoo Lee², Sang-Hwa Lee³, Jong Seok Bae¹, Ju-Hun Lee¹, Tae Jung Kim⁴, Sang-Bae Ko⁴, Sang-Wuk Jeong⁵, Dong-Eog Kim⁵, Wi-Sun Ryu⁵

Affiliations

¹ Department of Neurology, Hallym University Kangdong Sacred Heart Hospital, Seoul, Republic of Korea.
² Department of Neurology, Hallym University Sacred Heart Hospital, Hallym Neurological Institute, Hallym University College of Medicine, Anyang, Republic of Korea.
³ Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea.
⁴ Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea.
⁵ Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea.

Abstract

Introduction: Detection of atrial fibrillation (AF) is crucial for preventing recurrence in patients with ischemic stroke. We aimed to examine whether the left atrial volume index (LAVI) and global longitudinal peak strain (GLPS) are associated with AF in patients with ischemic stroke.

Methods: We prospectively analyzed 678 consecutive patients with ischemic stroke. LAVI and GLPS were assessed using three-dimensional transthoracic echocardiography with speckle-tracking imaging. Multiple logistic regression was used to evaluate the association of AF with LAVI and GLPS. To evaluate the predictive value of LAVI and GLPS for the presence of AF, we used optimism-corrected c-statistics calculated by 100 bootstrap repetitions and the net reclassification improvement (NRI).

Results: The mean patient age was 68 ± 13 years (men, 60%). Patients with AF (18%) were a higher LAVI (41.7 ml/m² vs. 74.9 ml/m², P < 0.001) and a higher GLPS than those without AF (-14.0 vs. -17.3, P < 0.001). Among the 89 patients classified with embolic stroke of unknown source, the probable cardioembolic group had higher GLPS (n= 17, -14.6 vs. -18.6, respectively; P= 0.014) than the other groups (n= 72). Adding GLPS to age, hypertension, and the LAVI significantly improved the NRI, with an overall NRI improvement of 6.1% (P= 0.03).

Discussion: The LAVI andGLPS with speckle-tracking imaging echocardiography may help identify patients with AF.

Keywords: atrial fibrillation; embolic stroke of undetermined source; global longitudinal peak strain; ischemic stroke; left atrial volume index; speckle-tracking imaging echocardiography.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, Republic of Korea, and the Ministry of Food and Drug Safety) (Project Number: 1711195742).