Predictive Value of Left Atrial and Ventricular Strain for the Detection of Atrial Fibrillation in Patients With Cryptogenic Stroke

Gabriella Bufano; Francesco Radico; Carolina D'Angelo; Francesca Pierfelice; Maria Vittoria De Angelis; Massimiliano Faustino; Sante Donato Pierdomenico; Sabina Gallina; Giulia Renda

doi:10.3389/fcvm.2022.869076

Predictive Value of Left Atrial and Ventricular Strain for the Detection of Atrial Fibrillation in Patients With Cryptogenic Stroke

Front Cardiovasc Med. 2022 Apr 25:9:869076. doi: 10.3389/fcvm.2022.869076. eCollection 2022.

Authors

Gabriella Bufano¹, Francesco Radico², Carolina D'Angelo², Francesca Pierfelice¹, Maria Vittoria De Angelis³, Massimiliano Faustino⁴, Sante Donato Pierdomenico¹, Sabina Gallina⁵, Giulia Renda⁵

Affiliations

¹ Department of Innovative Technologies in Medicine & Dentistry, Institute of Cardiology, G. d'Annunzio University Chieti-Pescara, Chieti, Italy.
² Department of Cardiology, Renzetti Hospital, Lanciano, Italy.
³ Department of Neurology, Stroke Unit, SS Annunziata Hospital, Chieti, Italy.
⁴ Department of Cardiology, SS Annunziata Hospital, Chieti, Italy.
⁵ Department of Neuroscience, Imaging and Clinical Sciences, Institute of Cardiology, G. d'Annunzio University Chieti-Pescara, Chieti, Italy.

Abstract

Background and aims: Cryptogenic stroke (CS) is associated with a high rate of recurrences and adverse outcomes at long-term follow-up, especially due to its unknown etiology that often leads to ineffective secondary prevention. Asymptomatic atrial fibrillation (AF) could play an important pathophysiological role. Some studies have pointed to left atrial (LA) and left ventricular (LV) systolic and diastolic dysfunction as surrogate markers of AF. The aim of the study is to evaluate the relationship between echocardiographic parameters of LA and LV function, and the occurrence of AF revealed by continuous ECG monitoring in a cohort of patients with CS.

Methods: Single-center prospective cohort study. Seventy-two patients with CS with insertable cardiac monitors (ICM) underwent transthoracic echocardiography (TTE). TTE was focused on LA and LV function, including both standard and longitudinal strain-derived parameters. All detected AF episodes lasting more than 2 min were considered.

Results: Continuous ECG monitoring revealed subclinical AF in 23 patients (32%) at an average of 6.5 months after ICM implantation. Many echocardiographic parameters, indicating LA volume and LV systolic/diastolic function, were significantly associated with the occurrence of AF, suggesting the worst atrial function in the AF group. Furthermore, multivariable regression analysis revealed that peak atrial contraction strain and left ventricular strain were independently associated with AF (adjusted OR = 0.72, CI 95% 0.48-0.90, p = 0.005, and adjusted OR = 0.69, CI 95% 0.46-0.95, p = 0.041, respectively).

Conclusion: In patients with CS, LA and LV strain analysis add predictive value for the occurrence of AF over clinical and morpho-functional echocardiographic parameters. Impaired booster pump strain and LV longitudinal strain are strong and independent predictors of AF.

Keywords: atrial fibrillation; atrial myopathy; cryptogenic stroke; insertable cardiac monitor; left atrial strain; left ventricular longitudinal strain.