Atrial cardiopathy and stroke

Elkind, Mitchell S.V.

doi:10.1055/s-0042-1758385

Cited by 2 publications

(2 citation statements)

References 13 publications

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“…There is emerging evidence that empirical anticoagulation may prevent recurrent strokes in the absence of AF when atrial cardiopathy is recognized. 50 However, there is an urgent need to clarify the threshold of clinical significance and validate criteria for defining and measuring such markers of atrial cardiopathy. In the present review, left atrial size was variably reported in several studies potentially contributing to selection bias.…”

Section: Discussionmentioning

confidence: 99%

Use of risk scores for predicting new atrial fibrillation after ischemic stroke or transient ischemic attack—A systematic review

Kishore

Hossain

Cameron

et al. 2021

International Journal of Stroke

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Background Newly detected atrial fibrillation (NDAF) following an ischemic stroke or transient ischemic attack is often paroxysmal in nature. While challenging to detect, extended electrocardiographic (ECG) monitoring is often used to identify NDAF which has resource implications. Prognostic risk scores have been derived which may stratify the risk of NDAF and inform patient selection for ECG monitoring approaches after ischemic stroke/transient ischemic attack. Aim The overall aim was to identify risk scores that were derived and/or validated to predict NDAF after ischemic stroke/transient ischemic attack and evaluate their performance. Summary of review A systematic literature review was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, with application of the Quality Assessment of Diagnostic Accuracy-2 tool. Published studies, which derived and validated clinical risk scores in patients with ischemic stroke/transient ischemic attack, or externally validated an existing score to predict NDAF after ischemic stroke/transient ischemic attack, were considered and independently screened by two reviewers. Twenty-one studies involving 23 separate cohorts were analyzed from which 17 integer-based risk scores were identified. The overall frequency of NDAF was 9.7% (95% confidence intervals 8%–11.5%; I2 = 98%). The performance of the scores varied widely among derivation and validation cohorts (area under the receiver operating characteristic curve (AUC) 0.54–0.94); scores derived from stroke cohorts (12 scores) appeared to perform better (AUC 0.7–0.94) than those derived from non-stroke cohorts (five scores; AUC 0.53–0.79). The scores also varied considerably in their complexity, ascertainment, component variables, participant characteristics, outcome definition, and ease of application limiting their generalizability and utility. Conclusion Overall, the risk scores identified performed variably in their discriminative ability and the utility of these scores to predict NDAF in clinical practice remains uncertain. Further studies are required using larger prospective cohorts and randomized control trials to evaluate the usefulness of such scores for clinical decision making and preventative intervention.

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Section: Discussionmentioning

confidence: 99%

Use of risk scores for predicting new atrial fibrillation after ischemic stroke or transient ischemic attack—A systematic review

Kishore

Hossain

Cameron

et al. 2021

International Journal of Stroke

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“…AC describes functional and structural anomalies of LA [ 14 ] and is associated with several biomarkers, namely: LA enlargement, supraventricular ectopy, increase of P-wave terminal force in lead V1 (PTFV1) and increase of serum N-terminal pro-brain natriuretic peptide (NT-ProBNP) [ 15 ]. A consensual and standardized diagnostic tool has not yet been proposed.…”

Section: Introductionmentioning

confidence: 99%

Atrial cardiopathy in young adults with embolic stroke of undetermined source: a myocardial deformation imaging analysis

Pires

Silva

Garcia

et al. 2022

Int J Cardiovasc Imaging

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Background Atrial cardiopathy (AC) has emerged as a potential pathological thrombogenic atrial substract of embolic stroke of undetermined source (ESUS), even in the absence of atrial fibrillation. Left atrium (LA) myocardial deformation analysis may be of value as a subclinical marker of AC and a predictor of ESUS. Aims To compare LA mechanical function between ESUS cases and age and sex-matched controls. Methods A single-center analytical study with case-control design was performed. Case group was composed by young patients admitted in the Neurology department from January 2017 to June 2021. Control group was composed by age and sex matched controls recruited from the community. All participants performed echocardiogram and a smaller sample underwent cardiac magnetic resonance. Results We recruited 31 ESUS patients aged between 18 and 65 years and 31 age and sex matched controls. ESUS patients had a significantly higher prevalence of cardiovascular risk factors and patent foramen ovale (PFO). The prevalence of AC was not different between groups. Echocardiogram parameters, including strain analysis, were similar between groups, except for LA appendage (LAA) ostium variation which was significantly lower in ESUS patients (absolute: 6.5vs8.7mm, p<0.001; relative: 44.5%vs53.4%, p=0.002). After exclusion of patients with PFO, all the results were statistically similar. Regarding cardiac magnetic resonance analysis, there were no statistically significant differences between groups. Conclusion This study shows that in our population atria cardiopathy and atrial function was not associated with ESUS.LAA structural and functional abnormalities may play a major role. The role of LAA in ESUS warrants further studies.

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Atrial cardiopathy and stroke

Cited by 2 publications

References 13 publications

Use of risk scores for predicting new atrial fibrillation after ischemic stroke or transient ischemic attack—A systematic review

Use of risk scores for predicting new atrial fibrillation after ischemic stroke or transient ischemic attack—A systematic review

Atrial cardiopathy in young adults with embolic stroke of undetermined source: a myocardial deformation imaging analysis

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