Left Atrial Strain Is Reduced in Patients with Atrial Fibrillation, Stroke or TIA, and Low Risk CHADS2 Scores

Azemi, Talhat; Rabdiya, Vimal; Ayirala, Srilatha R.; McCullough, Louise D.; Silverman, David I.

doi:10.1016/j.echo.2012.09.004

Cited by 88 publications

(68 citation statements)

References 47 publications

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“…This result has been previously reported in patients with decreased LAS and diagnosis of PAF. 7 LAS measures the lack of distensibility and contractility observed in the atrial remodeling effect, which trends to trigger atrial fibrillation. 8 In addition, patients who experience PAF episodes before the stroke may have had lower degree of atria contractility compared with those who remained in sinus rhythm.…”

Section: Results Of Pilot Testingmentioning

confidence: 99%

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Left Atria Strain Is a Surrogate Marker for Detection of Atrial Fibrillation in Cryptogenic Strokes

Pagola

González‐Alujas

Flores

et al. 2014

Stroke

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A fter complete diagnostic workup, a quarter of ischemic strokes are regarded as undetermined pathogenesis at discharge with a substantial rate of mortality in some cases. Paroxysmal atrial fibrillation (PAF) is the most frequent occult cause resulting in significant morbidity and costs when is under diagnosed.2 Recent studies have shown that extending the cardiac monitoring duration with subcutaneous implantable monitors and selecting patients for prolonged monitoring significantly increased the PAF detection in ischemic strokes. 3The left atria volume (LAv) has been used to assess the left atrial function. Nevertheless, the left atria dimension is predictive of stroke but become nonsignificant after adjustment for the older age. 4 The left atria function can be also obtained by the analysis of the left atria walls deformation, also called strain of the left atria. The speckle tracking is an echocardiographic technique that uses standard B-mode images for the analysis of the acoustic backscatter generated by the ultrasound beam. The changes between speckles are assumed to represent the strain. 5 The published intraobserver and interobserver variability of left atria strain (LAS) is 7.8%, and 8.9%, respectively. 6The LAS profile has been previously described in patients with PAF and in correlation with CHADS2 score (hypertension >140/90 mm Hg, age ≥75, diabetes, prior stroke), 7 but it has never been studied in cryptogenic ischemic strokes. Description of the InnovationWe aimed to describe the left atria functionality assessed by LAS parameter in cryptogenic strokes to improve the detection of occult PAF. With the purpose to obtain the best LAS cutoff point to differentiate patients with and without PAF, we planned the comparison as a case-control study. Accordingly, the selection of patients without PAF (non-PAF group) was made considering consecutive patients with cryptogenic stroke after complete workup evaluation with no PAF episodes in 3-year cardiac monitoring with Holter Reveal Tx to reduce the chance of a false-negative result. A group of patients with previously known PAF composed the PAF group. An informed consent was obtained from the patient or relatives.The same blinded sonographer performed the studies with the echocardiographic platform GE EchoPac Clinical ultrasound software. The LAS analysis was performed from the apical 4-chamber view, placing the 3.5-MHz multiphase array probe at the apex of the left ventricle. The atrial endocardium wall was first traced manually and followed by automatic estimation of the epicardial atrial surface. The atrial wall was divided into 6 segments by the software. Each 2 segments corresponded to the atrial septum, lateral wall, and the roof of the left atrium. The speckle tracking required 3 cardiac cycles digitally stored with a minimum of 50 frames per second. Those studies with inaccurate loop image were excluded. The software calculated the median longitudinal peak atrial strain (peak positive strain), which corresponded to the left atria distensibility. We de...

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Section: Results Of Pilot Testingmentioning

confidence: 99%

“…5 The published intraobserver and interobserver variability of left atria strain (LAS) is 7.8%, and 8.9%, respectively. 6 The LAS profile has been previously described in patients with PAF and in correlation with CHADS2 score (hypertension >140/90 mm Hg, age ≥75, diabetes, prior stroke), 7 but it has never been studied in cryptogenic ischemic strokes.…”

mentioning

confidence: 99%

Left Atria Strain Is a Surrogate Marker for Detection of Atrial Fibrillation in Cryptogenic Strokes

Pagola

González‐Alujas

Flores

et al. 2014

Stroke

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“…Среди лиц с постоянной ФП глобальная про-дольная деформация в фазу накопления (εs)<16,5% и отношение пиковой скорости диастолического транс-митрального потока Е к продольной деформации (Е/εs)>6.0 с высокой точностью выявляла лиц с риском кардиоваскулярных осложнений [56]. Параметры де-формации в систолу ЛП≤-5,0% с чувствительностью 93%, специфичностью 60% и отрицательным про-гностическим значением 92% предсказывали веро-ятность развития цереброваскулярного нарушения даже у лиц с низким риском согласно шкале CHADS 2 или CHA 2 DS 2 -VASc, то есть, имеющих ≤1 балла перед ин-сультом или транзиторной ишемической атакой [57]. Не менее эффективными показатели деформации были и в предсказании риска кардиоэмболического инсульта среди лиц без нарушений предсердного ритма [58].…”

Section: Left Atrial Function: Assessment and Clinical Significance фunclassified

Left Atrial Function: Modern Assessment Methods and Clinical Significance

Pavlyukova¹,

Kuzhel²,

Matyushin³

2017

Racionalʹnaâ farmakoterapiâ v kardiologii

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1 Научно-исследовательский институт кардиологии, Томский национальный исследовательский медицинский центр. Россия, 634012, Томск, ул. Киевская, 111а 2 Красноярский Государственный Медицинский Университет им. проф. В.Ф. Войно-Ясенецкого Россия, 660022, Красноярск, ул. Партизана Железняка, 1 3 Красноярская краевая больница №2.Россия, 660049, Красноярск, ул. Карла Маркса, 43Оценка функции левого предсердия (ЛП) является важным аспектом всестороннего исследования компетентности сердечно-сосудистой си-стемы. Многочисленные кардиальные заболевания могут влиять на работу ЛП, как непосредственно воздействуя на миокард предсердий, так и путем изменения состояния гемодинамики. Принято считать, что давление в ЛП и в левом желудочке в диастолу взаимозависимы, по-этому в отсутствие патологии митрального клапана расширение предсердия является признаком увеличения давления наполнения желудочка. Изучение размера и функции левого предсердия как функции накопления, протекания и насоса может предсказывать сердечно-сосудистые события при кардиомиопатиях, ишемической болезни сердца и клапанных пороках. В последние два десятилетия появились новые мето-дики, связанные, прежде всего с тканевыми допплеровскими технологиями, которые обеспечивают достаточно точную и всестороннюю оцен-ку механики левого предсердия. Деформация и скорость деформации, полученные ультразвуковой методикой «след пятна», представляет легко выполнимую и воспроизводимую технологию оценки механики левого предсердия. В нормальных условиях ЛП представляет собой очень растяжимую камеру с относительно низким давлением. Однако при остром или хро-ническом повреждающем воздействии происходит растяжение стенки ЛП. Расширение ЛП является признаком изменения его структуры с развитием фиброза, что отражается на показателях деформации и скорости деформации ЛП. Оценка деформации ЛП может быть полез-ной в предсказании успешности восстановления и сохранения синусового ритма после кардиоверсии и катетерной абляции. Низкие значе-ния глобальной деформации ЛП указывают на необратимое ремоделирование ЛП и связаны с прогрессированием фибрилляции предсер-дий от пароксизмальной формы к постоянной. Наиболее интересным в этой связи представляется потенциальный вклад эхокардиографии в стратификацию тромбоэмболического риска при фибрилляции предсердий и процедурах инвазивного вмешательства. Поэтому основной задачей в настоящее время является понимание точек клинического приложения полученных в ходе исследования ЛП данных применительно к текущей практике.Ключевые слова: эхокардиография, левое предсердие, деформация левого предсердия, функция левого предсердия, спекл-трекинг эхо-кардиография. Assessment of the left atrial (LA) function is important aspect of comprehensive cardiovascular system estimation. Many cardiac diseases make an impact to LA work either by direct affect on myocardium or hemodynamic condition changing. It is considered, LA and left ventricle diastolic pressure is interrelated, thus without mitral valve disease LA expanding is a sign of LV filling pressure augmentation. Exa...

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“…Likewise, several transthoracic echocardiographic parameters have shown promising value in the prediction of stroke/thromboembolism [50][51][52][53][54] or surrogate markers of stroke [55][56][57][58][59]. These include left atrial (LA) size measured on M-mode [50], indexed LA volume [51], left ventricular ejection fraction [57], E/E 0 ratio [52] and peak systolic LA strain rates assessed through speckletracking [54].…”

Section: Atrial Fibrillation and Stroke: Which Patients To Treat?mentioning

confidence: 99%

“…These include left atrial (LA) size measured on M-mode [50], indexed LA volume [51], left ventricular ejection fraction [57], E/E 0 ratio [52] and peak systolic LA strain rates assessed through speckletracking [54]. The presence of LA appendage thrombi, dense spontaneous echocardiographic contrast, LA appendage peak flow velocities <20 cm/s or complex aortic plaque associates with increased thromboembolic risk [60,61].…”

Section: Atrial Fibrillation and Stroke: Which Patients To Treat?mentioning

confidence: 99%

Untreated atrial fibrillation in the United Kingdom: Understanding the barriers and treatment options

Barra

Fynn

2015

Journal of the Saudi Heart Association

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Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a major preventable cause of stroke and hospitalization. Its prevalence is on the rise worldwide and experts believe it will continue to rise for the foreseeable future, due to the ageing population and increased survival from conditions associated with AF. Despite the fact that oral anticoagulation is effective in preventing strokes due to AF, there is extensive evidence suggesting this therapy remains underused. Barriers to the prescription of anticoagulation include patients' age per se, comorbidities, inadequate risk stratification, perceived risk of falls and bleeding, and the difficulty in achieving a stable international normalized ratio (INR) on warfarin. Also, asymptomatic patients with AF may not be identified and therefore not be candidates for anticoagulation. Physicians need continued better education on the identification of patients at risk of stroke and management of oral anticoagulation. This article reviews the barriers to anticoagulation in patients with AF in the United Kingdom and considers how those barriers may be overcome.

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Left Atrial Strain Is Reduced in Patients with Atrial Fibrillation, Stroke or TIA, and Low Risk CHADS2 Scores

Cited by 88 publications

References 47 publications

Left Atria Strain Is a Surrogate Marker for Detection of Atrial Fibrillation in Cryptogenic Strokes

Left Atria Strain Is a Surrogate Marker for Detection of Atrial Fibrillation in Cryptogenic Strokes

Left Atrial Function: Modern Assessment Methods and Clinical Significance

Untreated atrial fibrillation in the United Kingdom: Understanding the barriers and treatment options

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