Agathe Py1, Mathieu Schaaf1, Suzanne Duhamel1, Salim Si-Mohamed2, Jessica Daher1, Mikhaïl Altman3, Brigitte de Breyne4, Laura Mechtouff5, Joël Placide6, Samuel Chauveau4, Philippe Chevalier4, Norbert Nighoghossian5, Cyrille Bergerot1, Hélène Thibault7. 1. Service d'explorations fonctionnelles cardiovasculaires, groupement hospitalier Est, hospices civils de Lyon, hôpital Louis Pradel, 28, avenue Doyen-Lépine, 69677 Bron, France. 2. Department of thoracic and cardiac imaging, groupement hospitalier Est, hospices civils de Lyon, 69677 Bron, France. 3. Cardiology department, Westmead hospital, 2145 Westmead, NSW, Australia; University of Sydney, 2006 Camperdown, NSW, Australia. 4. Rhythmology division, groupement hospitalier Est, hospices civils de Lyon, hôpital Louis Pradel, 69677 Bron, France. 5. Stroke department, groupement hospitalier Est, hospices civils de Lyon, 69677 Bron, France. 6. CIC1407, centre d'investigation clinique de Lyon, hospices civils de Lyon, 69677 Bron, France. 7. Service d'explorations fonctionnelles cardiovasculaires, groupement hospitalier Est, hospices civils de Lyon, hôpital Louis Pradel, 28, avenue Doyen-Lépine, 69677 Bron, France. Electronic address: helene.thibault@chu-lyon.fr.
Abstract
BACKGROUND: Recent publications suggest that left atrial (LA) myopathy is a potential source of thromboembolism, independent of atrial fibrillation. AIMS: We sought to investigate whether the presence of atrial premature activity after an ischaemic stroke is associated with LA remodelling and dysfunction, and might be a surrogate marker of LA myopathy. METHODS: After an ischaemic stroke or a transient ischaemic attack, patients without known atrial fibrillation or overt heart disease were included prospectively in the study. All patients had a standard workup, including ambulatory Holter electrocardiogram monitoring and transthoracic echocardiography. In some patients, transoesophageal echocardiography was also performed. Anatomical and functional LA remodelling were assessed using minimal and maximal volumes and LA emptying fraction in two-dimensional and three-dimensional echocardiography. Patients were separated into two groups according to the burden of atrial premature complexes (APCs), measured by Holter electrocardiography. RESULTS: Among 148 eligible patients recruited from October 2015 to May 2016, 93 were included in the group with non-frequent APCs (nf-APC:<100 APCs/24hours) and 43 in the group with frequent APCs (f-APC:>100 APCs/24hours). Twelve patients had paroxysmal atrial fibrillation, and were not included in the statistical analysis. Maximal and minimal indexed LA volumes were significantly higher in the f-APC group than in the nf-APC group (P<0.01). LA emptying fraction was worse in the f-APC group than in the nf-APC group. In addition, LA appendage emptying velocity was impaired in the f-APC group, and was correlated with LA remodelling variables, especially LA emptying fraction (r=0.621). CONCLUSIONS: After an ischaemic stroke or a transient ischaemic attack, excessive APCs are associated with LA remodelling. Thus, LA dilatation and dysfunction reflect early LA myopathy, which might itself be responsible for cardioembolic stroke.
BACKGROUND: Recent publications suggest that left atrial (LA) myopathy is a potential source of thromboembolism, independent of atrial fibrillation. AIMS: We sought to investigate whether the presence of atrial premature activity after an ischaemic stroke is associated with LA remodelling and dysfunction, and might be a surrogate marker of LA myopathy. METHODS: After an ischaemic stroke or a transient ischaemic attack, patients without known atrial fibrillation or overt heart disease were included prospectively in the study. All patients had a standard workup, including ambulatory Holter electrocardiogram monitoring and transthoracic echocardiography. In some patients, transoesophageal echocardiography was also performed. Anatomical and functional LA remodelling were assessed using minimal and maximal volumes and LA emptying fraction in two-dimensional and three-dimensional echocardiography. Patients were separated into two groups according to the burden of atrial premature complexes (APCs), measured by Holter electrocardiography. RESULTS: Among 148 eligible patients recruited from October 2015 to May 2016, 93 were included in the group with non-frequent APCs (nf-APC:<100 APCs/24hours) and 43 in the group with frequent APCs (f-APC:>100 APCs/24hours). Twelve patients had paroxysmal atrial fibrillation, and were not included in the statistical analysis. Maximal and minimal indexed LA volumes were significantly higher in the f-APC group than in the nf-APC group (P<0.01). LA emptying fraction was worse in the f-APC group than in the nf-APC group. In addition, LA appendage emptying velocity was impaired in the f-APC group, and was correlated with LA remodelling variables, especially LA emptying fraction (r=0.621). CONCLUSIONS: After an ischaemic stroke or a transient ischaemic attack, excessive APCs are associated with LA remodelling. Thus, LA dilatation and dysfunction reflect early LA myopathy, which might itself be responsible for cardioembolic stroke.
Authors: Cassady Palmer; Vien T Truong; Jeremy A Slivnick; Sarah Wolking; Paige Coleman; Wojciech Mazur; Karolina M Zareba Journal: Sci Rep Date: 2022-01-07 Impact factor: 4.379