Relation Between Left Atrial Enlargement and Stroke Subtypes in Acute Ischemic Stroke Patients

Shin, Hoon−Kyu; Jeong, Inhye; Kang, Chang-Ki; Shin, Dong Ju; Park, Hyeon-Mi; Park, Kee-Hyung; Sung, Young-Hee; Noh, Young; Lee, Yeong-Bae

doi:10.7461/jcen.2013.15.3.131

Cited by 21 publications

(13 citation statements)

References 16 publications

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“…Second, patients in the conventional cardiac monitoring cohort had a 2-fold higher prevalence of left atrial enlargement in the echocardiography compared with those in the ICM cohort. Taking into account the association of left atrial enlargement with underlying PAF, as uncovered in our analyses and highlighted in previous studies from our group 10 and other investigators, 24,25 we expect that the true incidence of PAF in the conventional cardiac monitoring cohort would be much higher than that uncovered in the ICM cohort. Third, the prevalence of valvular disease, which also has been independently associated with the probability of PAF detection in patients with cryptogenic stroke, 26,27 was also 3 times higher in patients receiving conventional cardiac monitoring compared to patients receiving ICM.…”

Section: Discussionsupporting

confidence: 62%

Implantable Cardiac Monitoring in the Secondary Prevention of Cryptogenic Stroke

Triantafyllou

Katsanos

Dilaveris

et al. 2020

Annals of Neurology

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In this study, we sought to evaluate the impact of implantable cardiac monitoring (ICM) in the prevention of stroke recurrence after a cryptogenic ischemic stroke or transient ischemic attack (TIA). Methods: We evaluated consecutive patients with cryptogenic ischemic stroke or TIA admitted in a comprehensive stroke center during an 8-year period. We compared the baseline characteristics and outcomes between patients receiving conventional cardiac monitoring with repeated 24-hour Holter-monitoring during the first 5 years in the outpatient setting and those receiving continuous cardiac monitoring with ICM during the last 3 years. Associations on the outcomes of interest were further assessed in multivariable regression models adjusting for potential confounders. Results: We identified a total of 373 patients receiving conventional cardiac monitoring and 123 patients receiving ICM. Paroxysmal atrial fibrillation (PAF) detection was higher in the ICM cohort compared to the conventional cardiac monitoring cohort (21.1% vs 7.5%, p < 0.001). ICM was independently associated with an increased likelihood of PAF detection during follow-up (hazard ratio [HR] = 1.94, 95% confidence interval [CI] = 1.16-3.24) in multivariable analyses. Patients receiving ICM were also found to have significantly higher rates of anticoagulation initiation (18.7% vs 6.4%, p < 0.001) and lower risk of stroke recurrence (4.1% vs 11.8%, p = 0.013). ICM was independently associated with a lower risk of stroke recurrence during follow-up (HR = 0.32, 95% CI = 0.11-0.90) in multivariable analyses. Interpretation: ICM appears to be independently associated with a higher likelihood of PAF detection and anticoagulation initiation after a cryptogenic ischemic stroke or TIA. ICM was also independently related to lower risk of stroke recurrence in our cryptogenic stroke / TIA cohort.

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Section: Discussionsupporting

confidence: 62%

Implantable Cardiac Monitoring in the Secondary Prevention of Cryptogenic Stroke

Triantafyllou

Katsanos

Dilaveris

et al. 2020

Annals of Neurology

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“…Enlarged LA diameter (with addition of elevated thromboembolic risk in the CHADS 2 score) is a predictor of incident LA thrombi [ 21 ]. As a consequence, patients with LA enlargement are at higher risk of stroke, and majority of the stroke type occurring in this group are cardioembolic strokes [ 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Association of the CHADS2 and CHA2DS2-VASc scores with left atrial enlargement: a prospective cohort study of unselected atrial fibrillation patients

Hrynkiewicz−Szymańska

Dłużniewski

Płatek

et al. 2014

J Thromb Thrombolysis

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Assessment of thromboembolic risk is crucial for proper management of atrial fibrillation (AF) patients. Currently used risk score base only on scarce clinical data and do not take into consideration parameters including echocardiographic findings. The aim of this study was to evaluate if left atrium (LA) enlargement is associated with higher thromboembolic risk assessed by CHADS2 and CHA2DS2-VASc scores in a cohort of unselected non-valvular AF patients. Data from 582 AF hospitalizations occurring between November 2012 and January 2014 were analyzed. All patients underwent a standard transthoracic echocardiography and had their thromboembolic risk assessed in both CHADS2 and CHA2DS2-VASc scores. In 494 enrolled patients (48.5 % male; mean age 73.4 ± 11.5 years) AF was classified as paroxysmal in 233 (47.3 %), as persistent in 109 (22.1 %), and as permanent in 151 (30.6 %) patients. LA was enlarged in 426 (86.2 %) patients. Enlargement was classified as mild in 99 (20.0 %) patients, as moderate in 130 (26.3 %) patients, and as severe in 196 (39.7 %) patients. Patients with enlarged LA had higher mean CHADS2 score (2.0 ± 1.5 vs. 2.6 ± 1.3; p = 0.0005) and CHA2DS2-VASc (3.8 ± 2.0 vs. 4.4 ± 1.8; p = 0.02) score than patients with normal LA. The both mean scores rose along with rising LA diameter. LA enlargement is highly prevalent in AF patients. Higher thromboembolic risk assessed by both CHADS2 and CHA2DS2-VASc scores is associated with presence of LA enlargement. Echocardiographically assessed LA size may be an additional parameter useful in thromboembolic risk stratification of AF patients.

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“…Second, compared to other types of ischemic stroke, CE has a more abrupt onset with more severe conditions and a higher NIHSS score [ 16 , 17 ]. Third, a number of recent studies have confirmed that left atrial enlargement is correlated with stroke and can increase the risk of stroke [ 18 – 20 ], especially the risk of CE [ 21 ].As an important etiological factor in stroke of undetermined etiology [ 22 ]and an independent risk factor for CE and the recurrence of cryptogenic stroke [ 23 ],left atrial enlargement is associated with the stroke severity [ 24 ].Additionally, left atrial enlargement may lead to local thrombosis [ 25 ]. Jaroch et al found that a left atrial diameter greater than 51 mm was an independent risk factor for predicting thrombus in the left atrial appendage [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of STAF score in combination with D-dimer in cardioembolism

Liu

Guo

et al. 2018

PLoS ONE

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The aim of this study was to evaluate the diagnostic value of the Score for the Targeting of Atrial Fibrillation (STAF) in combination with the serum D-dimer (DD) levels in cardioembolism(CE).This study was a retrospective case-onlystudy, consecutively including patients with acute ischemic stroke. All patients were evaluated following the STAF scoring criteria and were classified according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) etiology classification criteria. A total of 317 patients were enrolled, including 37 CE cases (11.67%). STAF ≥5 showed a sensitivity of 89% and a specificity of 91% for the diagnosis of CE, whereas DD >791.30 ng/mL had a sensitivity of 58% and a specificity of 78%. When the STAF was used in combination with the DD level, the sensitivity was 95%, and the specificity was 100%.STAF score is an excellent tool for the diagnosis of CE when combined with DD, and can facilitate the etiological classification of acute ischemic stroke.

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Relation Between Left Atrial Enlargement and Stroke Subtypes in Acute Ischemic Stroke Patients

Cited by 21 publications

References 16 publications

Implantable Cardiac Monitoring in the Secondary Prevention of Cryptogenic Stroke

Implantable Cardiac Monitoring in the Secondary Prevention of Cryptogenic Stroke

Association of the CHADS2 and CHA2DS2-VASc scores with left atrial enlargement: a prospective cohort study of unselected atrial fibrillation patients

Diagnostic value of STAF score in combination with D-dimer in cardioembolism

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