Predicting Paroxysmal Atrial Fibrillation in Cerebrovascular Ischemia Using Tissue Doppler Imaging and Speckle Tracking Echocardiography

Flemming Javier Olsen; Peter Godsk Jørgensen; Rasmus Møgelvang; Jan Skov Jensen; Thomas Fritz-Hansen; Jan Bech; Tor Biering-Sørensen

doi:10.1016/j.jstrokecerebrovasdis.2015.10.004

Predicting Paroxysmal Atrial Fibrillation in Cerebrovascular Ischemia Using Tissue Doppler Imaging and Speckle Tracking Echocardiography

J Stroke Cerebrovasc Dis. 2016 Feb;25(2):350-9. doi: 10.1016/j.jstrokecerebrovasdis.2015.10.004. Epub 2015 Nov 2.

Authors

Flemming Javier Olsen¹, Peter Godsk Jørgensen², Rasmus Møgelvang³, Jan Skov Jensen², Thomas Fritz-Hansen³, Jan Bech³, Tor Biering-Sørensen⁴

Affiliations

¹ Department of Cardiology, Herlev Gentofte Hospital, University of Copenhagen, Denmark. Electronic address: flemming.j.olsen@gmail.com.
² Department of Cardiology, Herlev Gentofte Hospital, University of Copenhagen, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
³ Department of Cardiology, Herlev Gentofte Hospital, University of Copenhagen, Denmark.
⁴ Department of Cardiology, Herlev Gentofte Hospital, University of Copenhagen, Denmark; Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

PMID: 26542824
DOI: 10.1016/j.jstrokecerebrovasdis.2015.10.004

Abstract

Background: Often the underlying cause of cerebral ischemia (CI) cannot be found during a routine diagnostic investigation, but paroxysmal atrial fibrillation (PAF) could be the culprit.

Aim: The objective of the study is to investigate whether advanced echocardiography improves the diagnostic approach for PAF in CI.

Methods: The study included 286 CI patients with an echocardiogram in sinus rhythm. Patients were divided by PAF occurrence (PAF: n = 86, non-PAF: n = 200). PAF was defined as 1 or more reported episodes of atrial fibrillation. Echocardiograms consisted of conventional measures, tissue Doppler imaging (TDI), and speckle tracking. TDI was performed to acquire myocardial peak velocities during systole/ventricular contraction (global s'), early diastole/ventricular filling (global e'), and late diastole/atrial contraction (global a'). Speckle tracking was performed for myocardial strain analysis, thereby retrieving global longitudinal strain and global strain rate (s, e, a) values.

Results: Patients with PAF exhibited significantly impaired atrial contractile measures: global a' (-7.0 cm/second versus -5.7 cm/second, P < .001) and global strain rate a (.97 second(-1) versus .81 second(-1), P < .001). Both were univariable markers of PAF, and along with age remained the only independent significant determinants of PAF after multivariable logistic regression. Area under the curve (AUC) for age, global a', and global strain rate a significantly exceeded AUC for age alone (.79 versus .76, P = .032). Cutoff values with the highest sensitivity and specificity for these 3 parameters improved the diagnostic accuracy (sensitivity = 97%, specificity = 32%, negative predictive value = 95%, and positive predictive value = 38%).

Conclusions: Atrial contractile measures by advanced echocardiography are significant determinants of PAF in CI. However, there is no discriminatory power to make them clinically useful at the current moment.

Keywords: Ischemic stroke; atrial fibrillation; cardioembolic stroke; echocardiography; speckle tracking; tissue Doppler imaging.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Atrial Fibrillation / complications
Atrial Fibrillation / diagnostic imaging*
Brain Ischemia / complications
Brain Ischemia / diagnostic imaging*
Echocardiography, Doppler
Female
Heart Atria / diagnostic imaging*
Humans
Male
Middle Aged
Reproducibility of Results
Sensitivity and Specificity