Benjamin Y Q Tan1,2, Jamie Sin Ying Ho3, Ching-Hui Sia4,5, Yushan Boi2, Anthia S M Foo2, Mayank Dalakoti6, Mark Y Chan2,6, Andrew F W Ho7, Aloysius S Leow1, Bernard P L Chan1, Hock Luen Teoh1, Swee Chong Seow6, Pipin Kojodjojo6, Raymond C S Seet1,2, Vijay K Sharma1,2, Leonard Leong L Yeo1,2. 1. Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore. 2. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. 3. Department of Medicine, University of Cambridge, Cambridge, United Kingdom. 4. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore, ching_hui_sia@nuhs.edu.sg. 5. Department of Cardiology, National University Heart Centre, Singapore, Singapore, ching_hui_sia@nuhs.edu.sg. 6. Department of Cardiology, National University Heart Centre, Singapore, Singapore. 7. Cardiovascular & Metabolic Disorders Programme, Duke-NUS Medical School, Singapore, Singapore.
Abstract
INTRODUCTION: It is unclear which surrogate of atrial cardiopathy best predicts the risk of developing a recurrent ischemic stroke in embolic stroke of undetermined source (ESUS). Left atrial diameter (LAD) and LAD index (LADi) are often used as markers of left atrial enlargement in current ESUS research, but left atrial volume index (LAVi) has been found to be a better predictor of cardiovascular outcomes in other patient populations. OBJECTIVE: We aim to compare the performance of LAVi, LAD, and LADi in predicting the development of new-onset atrial fibrillation (AF) and stroke recurrence in ESUS. METHODS: Between October 2014 and October 2017, consecutive patients diagnosed with ESUS were followed for new-onset AF, ischemic stroke recurrence, and a composite outcome of occult AF and stroke recurrence. LAVi and LADi were measured by transthoracic echocardiogram; "high" LAVi was defined as ≥35 mL/m2 in accordance with American Society of Echocardiography guidelines. RESULTS: 185 ischemic stroke patients with ESUS were recruited and followed for a median duration of 2.1 years. Increased LAVi was associated with new-onset AF detection (aOR 1.08; 95% CI 1.03-1.14; p = 0.003) and stroke recurrence (aOR 1.05; 95% CI 1.01-1.10; p = 0.026). Patients with "high" LAVi had a higher likelihood of developing a composite of AF detection and stroke recurrence (HR 3.45; 95% CI 1.55-7.67; p = 0.002). No significant association was observed between LADi and either occult AF or stroke recurrence. CONCLUSIONS: LAVi is associated with new-onset AF and stroke recurrence in ESUS patients and may be a better surrogate of atrial cardiopathy.
INTRODUCTION: It is unclear which surrogate of atrial cardiopathy best predicts the risk of developing a recurrent ischemic stroke in embolic stroke of undetermined source (ESUS). Left atrial diameter (LAD) and LAD index (LADi) are often used as markers of left atrial enlargement in current ESUS research, but left atrial volume index (LAVi) has been found to be a better predictor of cardiovascular outcomes in other patient populations. OBJECTIVE: We aim to compare the performance of LAVi, LAD, and LADi in predicting the development of new-onset atrial fibrillation (AF) and stroke recurrence in ESUS. METHODS: Between October 2014 and October 2017, consecutive patients diagnosed with ESUS were followed for new-onset AF, ischemic stroke recurrence, and a composite outcome of occult AF and stroke recurrence. LAVi and LADi were measured by transthoracic echocardiogram; "high" LAVi was defined as ≥35 mL/m2 in accordance with American Society of Echocardiography guidelines. RESULTS: 185 ischemic strokepatients with ESUS were recruited and followed for a median duration of 2.1 years. Increased LAVi was associated with new-onset AF detection (aOR 1.08; 95% CI 1.03-1.14; p = 0.003) and stroke recurrence (aOR 1.05; 95% CI 1.01-1.10; p = 0.026). Patients with "high" LAVi had a higher likelihood of developing a composite of AF detection and stroke recurrence (HR 3.45; 95% CI 1.55-7.67; p = 0.002). No significant association was observed between LADi and either occult AF or stroke recurrence. CONCLUSIONS: LAVi is associated with new-onset AF and stroke recurrence in ESUS patients and may be a better surrogate of atrial cardiopathy.
Authors: Slaven Pikija; Cornelia Rösler; Ursula Leitner; Thomas Zellner; Nele Bubel; Bernhard Ganser; Constantin Hecker; Johannes Sebastian Mutzenbach Journal: Front Neurol Date: 2022-01-28 Impact factor: 4.003
Authors: Maurizio Acampa; Alessandra Cartocci; Carlo Domenichelli; Rossana Tassi; Francesca Guideri; Pietro Enea Lazzerini; Giuseppe Martini Journal: Front Cardiovasc Med Date: 2022-06-20