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Septal total atrial conduction time for prediction of atrial fibrillation in embolic stroke of unknown source: a pilot study

BACKGROUND: Subclinical atrial fibrillation (AF) is the underlying cause in a relevant part of patients with embolic stroke of unknown source (ESUS). This pilot study aims to identify novel echocardiographic parameters predicting AF subsequently detected in patients originally hospitalized with ESUS...

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Autores principales: Sieweke, Jan-Thorben, Biber, Saskia, Weissenborn, Karin, Heuschmann, Peter U., Akin, Muharrem, Zauner, Florian, Gabriel, Maria M., Schuppner, Ramona, Berliner, Dominik, Bauersachs, Johann, Grosse, Gerrit M., Bavendiek, Udo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6989646/
https://www.ncbi.nlm.nih.gov/pubmed/31236691
http://dx.doi.org/10.1007/s00392-019-01501-2
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author Sieweke, Jan-Thorben
Biber, Saskia
Weissenborn, Karin
Heuschmann, Peter U.
Akin, Muharrem
Zauner, Florian
Gabriel, Maria M.
Schuppner, Ramona
Berliner, Dominik
Bauersachs, Johann
Grosse, Gerrit M.
Bavendiek, Udo
author_facet Sieweke, Jan-Thorben
Biber, Saskia
Weissenborn, Karin
Heuschmann, Peter U.
Akin, Muharrem
Zauner, Florian
Gabriel, Maria M.
Schuppner, Ramona
Berliner, Dominik
Bauersachs, Johann
Grosse, Gerrit M.
Bavendiek, Udo
author_sort Sieweke, Jan-Thorben
collection PubMed
description BACKGROUND: Subclinical atrial fibrillation (AF) is the underlying cause in a relevant part of patients with embolic stroke of unknown source (ESUS). This pilot study aims to identify novel echocardiographic parameters predicting AF subsequently detected in patients originally hospitalized with ESUS. METHODS AND RESULTS: Patients with acute ischemic stroke [baseline diagnosis of ESUS (n = 69), stroke of macro- or microvascular cause (n = 16/25), stroke caused by AF (n = 5)] and controls with paroxysmal AF without acute ischemic stroke (n = 22) as well as healthy controls of young and old age (n = 21/17) in sinus rhythm were included (overall n = 175). Echocardiography was performed in all participants. Prolonged Holter-ECG-monitoring was performed in all stroke patients. In the overall cohort, septal total atrial conduction time (sPA-TDI), left atrial (LA) volume index to tissue Doppler velocity (LAVI/a`) and second negative peak strain rate during LA contraction (SRa), representing echocardiographic parameters of LA remodelling and function, were statistically significant different in patients with and without AF and predictive for subclinical AF (multivariate regression analysis: sPA-TDI: HR 1.06 [1.04–1.08], p < 0.001; LAVI/a`: HR 0.85, [0.74–0.97], p = 0.02; SRa: HR 2.35 [0.9–5.5], p = 0.05). Multivariate Cox regression analysis revealed sPA-TDI as an independent predictor of AF in ESUS patients (sPA-TDI: HR 1.10 [1.04–1.17], p = 0.001). A sPA-TDI of 126 ms strictly discriminated between presence and absence of subclinical AF within 48 h after initiation of Holter-ECG-monitoring in ESUS patients. CONCLUSIONS: sPA-TDI seems to be a strong independent predictor of subclinical AF in patients hospitalized for ESUS and might support risk-stratified clinical decision making in these patients. GRAPHIC ABSTRACT: Septal Total Atrial Conduction Time (sPA-TDI) determined by echocardiography for prediction of Atrial Fibrillation in Embolic Stroke of Unknown Source (ESUS). [Image: see text] ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00392-019-01501-2) contains supplementary material, which is available to authorized users.
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spelling pubmed-69896462020-02-11 Septal total atrial conduction time for prediction of atrial fibrillation in embolic stroke of unknown source: a pilot study Sieweke, Jan-Thorben Biber, Saskia Weissenborn, Karin Heuschmann, Peter U. Akin, Muharrem Zauner, Florian Gabriel, Maria M. Schuppner, Ramona Berliner, Dominik Bauersachs, Johann Grosse, Gerrit M. Bavendiek, Udo Clin Res Cardiol Original Paper BACKGROUND: Subclinical atrial fibrillation (AF) is the underlying cause in a relevant part of patients with embolic stroke of unknown source (ESUS). This pilot study aims to identify novel echocardiographic parameters predicting AF subsequently detected in patients originally hospitalized with ESUS. METHODS AND RESULTS: Patients with acute ischemic stroke [baseline diagnosis of ESUS (n = 69), stroke of macro- or microvascular cause (n = 16/25), stroke caused by AF (n = 5)] and controls with paroxysmal AF without acute ischemic stroke (n = 22) as well as healthy controls of young and old age (n = 21/17) in sinus rhythm were included (overall n = 175). Echocardiography was performed in all participants. Prolonged Holter-ECG-monitoring was performed in all stroke patients. In the overall cohort, septal total atrial conduction time (sPA-TDI), left atrial (LA) volume index to tissue Doppler velocity (LAVI/a`) and second negative peak strain rate during LA contraction (SRa), representing echocardiographic parameters of LA remodelling and function, were statistically significant different in patients with and without AF and predictive for subclinical AF (multivariate regression analysis: sPA-TDI: HR 1.06 [1.04–1.08], p < 0.001; LAVI/a`: HR 0.85, [0.74–0.97], p = 0.02; SRa: HR 2.35 [0.9–5.5], p = 0.05). Multivariate Cox regression analysis revealed sPA-TDI as an independent predictor of AF in ESUS patients (sPA-TDI: HR 1.10 [1.04–1.17], p = 0.001). A sPA-TDI of 126 ms strictly discriminated between presence and absence of subclinical AF within 48 h after initiation of Holter-ECG-monitoring in ESUS patients. CONCLUSIONS: sPA-TDI seems to be a strong independent predictor of subclinical AF in patients hospitalized for ESUS and might support risk-stratified clinical decision making in these patients. GRAPHIC ABSTRACT: Septal Total Atrial Conduction Time (sPA-TDI) determined by echocardiography for prediction of Atrial Fibrillation in Embolic Stroke of Unknown Source (ESUS). [Image: see text] ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00392-019-01501-2) contains supplementary material, which is available to authorized users. Springer Berlin Heidelberg 2019-06-24 2020 /pmc/articles/PMC6989646/ /pubmed/31236691 http://dx.doi.org/10.1007/s00392-019-01501-2 Text en © The Author(s) 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Paper
Sieweke, Jan-Thorben
Biber, Saskia
Weissenborn, Karin
Heuschmann, Peter U.
Akin, Muharrem
Zauner, Florian
Gabriel, Maria M.
Schuppner, Ramona
Berliner, Dominik
Bauersachs, Johann
Grosse, Gerrit M.
Bavendiek, Udo
Septal total atrial conduction time for prediction of atrial fibrillation in embolic stroke of unknown source: a pilot study
title Septal total atrial conduction time for prediction of atrial fibrillation in embolic stroke of unknown source: a pilot study
title_full Septal total atrial conduction time for prediction of atrial fibrillation in embolic stroke of unknown source: a pilot study
title_fullStr Septal total atrial conduction time for prediction of atrial fibrillation in embolic stroke of unknown source: a pilot study
title_full_unstemmed Septal total atrial conduction time for prediction of atrial fibrillation in embolic stroke of unknown source: a pilot study
title_short Septal total atrial conduction time for prediction of atrial fibrillation in embolic stroke of unknown source: a pilot study
title_sort septal total atrial conduction time for prediction of atrial fibrillation in embolic stroke of unknown source: a pilot study
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6989646/
https://www.ncbi.nlm.nih.gov/pubmed/31236691
http://dx.doi.org/10.1007/s00392-019-01501-2
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