A correlation of the ratio of left atrial volume to left ventricular ejection fraction in predicting atrial fibrillation in ischemic stroke
Left atrial volume index and ischemic stroke
Keywords:ischemic stroke, atrial fibrillation, left atrial volume, ejection fraction
Background/Aim: The enlargement of left atrial volume index (LAVI) in diastolic dysfunction (DD) may predispose one to atrial fibrillation (AF) and is an important etiological reason for ischemic stroke (IS). The ratio of LAVI increase to left ventricular ejection fraction (LVEF) is a new parameter, and this work investigates the correlation between DD parameters, LAVI, LAVI/LVEF ratio, and AF in patients with sinus rhythm presenting with IS.
Methods: Here, 108 consecutive individuals who were diagnosed with IS were included in the case-control study. The patients were divided into two groups: Those with AF events on rhythm Holters (AF group, n=57) and those without (control group, n=51). LAVI was calculated from the apical four- and two-chamber views before the mitral valve was opened. LVEF was calculated by Simpson's method.
Results: The mean age of the AF group was 73.9 (6.3) years, and the control group was 72.1 (3.9) years. Hypertension, diabetes mellitus, glucose, HbA1c, CHA₂DS₂-VASc score, and previous stroke were higher in the AF group (P<0.05). LAVI (35.7 [25.3-38.2] vs 29.6 [27.7-30.9], P<0.001), the LAVI/LVEF ratio (0.7 [0.63-0.77] vs 0.5 [0.50-0.54], P<0.001), and the E/é ratio (14.6 [13.9-15.0] vs 10.7 [9.0-11.8], P<0.001) were higher in patients with AF. Multivariable analyses showed that LAVI (OR:7.985, 95%CI [2.586-4.767], P<0.001) and the LAVI/LVEF ratio (OR:0.010, 95% CI [0.000-0.007], P=0.015) were potential independent risk factors for AF events. A positive correlation was found between the CHA₂DS₂-VASc score and LAVI (P=0.032, r=0.407) and LAVI/LVEF ratio (P=0.041, r=0.253).
Conclusion: We concluded that the increase in LAVI and LAVI/LVEF ratio increases the risk of IS by increasing the tendency to AF. These parameters are useful in predicting IS.
Powers WJ, Rabinstein AA, Teri Ackerson, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/ American Stroke Association. Stroke. 2019;50(12):344-418. DOI: https://doi.org/10.1161/STR.0000000000000211
Cheung CC, Nattel S, Macle L, Andrade JG. Atrial Fibrillation Management in 2021: An updated Comparison of the Current CCS/CHRS, ESC, and AHA/ACC/HRS Guidelines. Can J Cardiol. 2021;26: S0828-282X(21)00313-5.
Singer DE, Chang Y, Borowsky LH, Fang MC, Pomernacki NK, Udaltsova N, et al. A new risk scheme to predict ischemic stroke and other thromboembolism in atrial fibrillation: ATRIA study stroke risk score. J Am Heart Assoc. 2013;2(3):e000250. DOI: https://doi.org/10.1161/JAHA.113.000250
Pieske B, Tschöpe C, de Boer RA, Fraser AG, Anker SD, Donal E, et al. How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the Europan Society of Cardiology (ESC). Eur Heart J. 2019;40(40):3297-317. DOI: https://doi.org/10.1093/eurheartj/ehz641
Thomas L, Abhayaratna WP. Left Atrial Reverse Remodeling: Mechanisms, Evaluation, and Clinical Significance. JACC Cardiovasc Imaging. 2017;(1)10:65-77. DOI: https://doi.org/10.1016/j.jcmg.2016.11.003
Steinberg JS, Varma N, Cygankiewicz I, P Aziz, Balsam P, Baranchuk A, et al. 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry. Heart Rhythm. 2017;14(7):e55-96. DOI: https://doi.org/10.1016/j.hrthm.2017.03.038
Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-thoracic Surgery (EACTS). Eur Heart J. 2021;42(5):373-498. DOI: https://doi.org/10.1093/eurheartj/ehaa945
Mitchell C, Rahko S, Blauwet LA, et al. Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in adults: Recommendation from the American Society of Echocardiography. J Am Soc Echocardiogr. 2019;32(1):1-64. DOI: https://doi.org/10.1016/j.echo.2018.06.004
Nagueh SF, Smiseth OA, Appleton CP, Dokainish H, Edvardsen T, Flachskampf FA, et al. Recommendations for the Evaluation of Left Diastolic Function by Echocardiography: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2016;17(12):1321-60. DOI: https://doi.org/10.1093/ehjci/jew082
Nattel S, Burstein B, Dobrev D. Atrial remodelling and atrial fibrillation: mechanisms and implications. Circ Arrhythm Electrophysiol. 2008;1(1):62-9. DOI: https://doi.org/10.1161/CIRCEP.107.754564
Ryu WS, Park JB, Ko SB, Hwang SK, Kim YJ, Kim DE, et al. Diastolic Dysfunction and Outcome in Acute Ischemic Stroke. Cerebrovasc Dis. 2016;41(3-4):148–55. DOI: https://doi.org/10.1159/000442006
Strahrenberg R, Edelman F, Haase B, Lahno R, Seegers J, Krüger MW, et al. Transthoracic Echocardiography to Rule Out Paroxysmal Atrial Fibrillation as a Cause of Stroke or Transient Ischemic Attack. Stroke. 2011;42(12):3643-5. DOI: https://doi.org/10.1161/STROKEAHA.111.632836
Waldenhjort D, Doliwa PS, Alam M, Kull VF, Engdahl J, Rosenqvist M, et al. Echocardiographic measures of atrial function may predict atrial fibrillation in stroke patients. Scand Cardiovasc J. 2016;50(4):236-42. DOI: https://doi.org/10.1080/14017431.2016.1175657
Sardana M, Lessard D, Tsao CW, Parikh NI, Barton BA, Nah G, et al. Association of Left Atrial Function Index with Atrial Fibrillation and Cardiovascular Disease: The Framingham Offspring Study. J Am Heart Assoc. 2018;7(7):e008435. DOI: https://doi.org/10.1161/JAHA.117.008435
Dharmendrakumar A, Patel. Prediction of All-Cause Mortality by the Left Atrial Volume Index in Patients With Normal Ventricular Filling Pressure and Preserved Ejection Fraction. 2015;90 (11):1499-505. DOI: https://doi.org/10.1016/j.mayocp.2015.07.021
Takeuchi M, Nabeshima Y, Kitano T, Negishi K, Prognostic value of the left ventricular-left atrial volume ratio assessed using three–dimensional echocardiography with fully automated analytical software, Journal of Cardiology. 2021;78 (5):406-12. DOI: https://doi.org/10.1016/j.jjcc.2021.05.004
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