Possible predictors of stroke in patients with atrial microfibrillation
https://doi.org/10.18087/cardio.2023.5.n2158
Abstract
Background Very short-lasting episodes of AF-like activity (micro-AF) may be precursors of undiagnosed silent episodes of atrial fibrillation. In this study, we examined the relationship between increased left atrial sphericity index (LASI) and stroke in patients with micro-AF.
Material and Methods A total of 100 consecutive patients with micro-AF enrolled in this study. The histories, cranial magnetic resonance, and computed tomography images of these patients were scanned from the hospital database. The patients were divided into two groups according to whether or not they had a stroke. LASI was calculated as a fraction of the left atrial maximum volume to the left atrial volume of the sphere in a 4‑chamber view. Atrial electromechanical delay (AEMD) intervals were calculated from the atrial wall and atrioventricular valve annulus levels by using tissue Doppler imaging (TDI). These two groups were compared in terms of stroke predictors.
Results A history of stroke was present in 25 (25 %) patients diagnosed with micro-AF (Group 1). 75 patients did not have stroke (Group 2). There was a significant difference between the two groups in terms of left atrial lateral wall electromechanical delay (LA lateral AEMD) times, left atrial volume index (LAVI), and left atrial sphericity index (LASI). Findings: LAVI, 40.9±3.72 vs. 29.9±3.84, p<0.001; LASI, 0.84±0.07 vs. 0.66±0.07, p<0.001; LA lateral AEMD, 77.2±4.85 vs. 66.5±3.66, p<0.001.
Conclusions Stroke precautions should be taken in patients with micro-AF. New predictive indexes should be given importance. Changes in LASI, LAVI and LA lateral AEMD values may be a predictor of stroke in patients with micro AF.
Supporting agencies: No conflict of interest is reported.
About the Author
Cihan Aydın
Namık Kemal University
Turkey
Turkey
MD
Department of Cardiology, Faculty of Medicine, Tekirdağ, Turkey
References
1. Wang TJ, Larson MG, Levy D, Vasan RS, Leip EP, Wolf PA et al. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation. 2003;107(23):2920–5. DOI: 10.1161/01.CIR.0000072767.89944.6E
2. Bisbal F, Guiu E, Calvo N, Marin D, Berruezo A, Arbelo E et al. Left Atrial Sphericity: A New Method to Assess Atrial Remodeling. Impact on the Outcome of Atrial Fibrillation. Journal of Cardiovascular Electrophysiology. 2013;24(7):752–9. DOI: 10.1111/jce.12116
3. Bisbal F, Guiu E, Cabanas P, Calvo N, Berruezo A, Tolosana JM et al. Reversal of spherical remodelling of the left atrium after pulmonary vein isolation: incidence and predictors. Europace. 2014;16(6):840–7. DOI: 10.1093/europace/eut385
4. Kemp Gudmundsdottir K, Fredriksson T, Svennberg E, Al-Khalili F, Friberg L, Frykman V et al. Stepwise mass screening for atrial fibrillation using N-terminal B-type natriuretic peptide: the STROKESTOP II study. EP Europace. 2020;22(1):24–32. DOI: 10.1093/europace/euz255
5. Binici Z, Intzilakis T, Nielsen OW, Køber L, Sajadieh A. Excessive Supraventricular Ectopic Activity and Increased Risk of Atrial Fibrillation and Stroke. Circulation. 2010;121(17):1904–11. DOI: 10.1161/CIRCULATIONAHA.109.874982
6. Murakoshi N, Xu D, Sairenchi T, Igarashi M, Irie F, Tomizawa T et al. Prognostic impact of supraventricular premature complexes in community-based health checkups: The Ibaraki Prefectural Health Study. European Heart Journal. 2015;36(3):170–8. DOI: 10.1093/eurheartj/ehu407
7. Shi J, Xu S, Chen L, Wu B, Yang K, Chen S et al. Impact of Left Atrial Sphericity Index on the Outcome of Catheter Ablation for Atrial Fibrillation. Journal of Cardiovascular Translational Research. 2021;14(5):912–20. DOI: 10.1007/s12265-020-10093-6
8. Grecu M, Floria M, Chistol R-O, Tinică Gr. Reverse left atrial remodeling assessment after paroxysmal atrial fibrillation ablation: our first experience. Revista medico-chirurgicala a Societatii de Medici si Naturalisti din Iasi. 2017;121(3):499–504. [Av/ at: https://www.researchgate.net/publication/320991372_INTERNAL_MEDICINEPEDIATRICS_REVERSE_LEFT_ATRIAL_REMODELING_ASSESSMENT_AFTER_PAROXYSMAL_ATRIAL_FIBRILLATION_ABLATION_OUR_FIRST_EXPERIENCE]
9. Ari H, Ari S, Akkaya M, Aydin C, Emlek N, Sarigül OY et al. Predictive value of atrial electromechanical delay for atrial fibrillation recurrence. Cardiology Journal. 2013;20(6):639–47. DOI: 10.5603/CJ.2013.0164
10. Fredriksson T, Gudmundsdottir KK, Frykman V, Friberg L, Al-Khalili F, Engdahl J et al. Brief episodes of rapid irregular atrial activity (micro-AF) are a risk marker for atrial fibrillation: a prospective cohort study. BMC cardiovascular disorders. 2020;20(1):167. DOI: 10.1186/s12872-020-01453-w
11. Bisbal F, Gómez-Pulido F, Cabanas-Grandío P, Akoum N, Calvo M, Andreu D et al. Left Atrial Geometry Improves Risk Prediction of Thromboembolic Events in Patients With Atrial Fibrillation. Journal of Cardiovascular Electrophysiology. 2016;27(7):804–10. DOI: 10.1111/jce.12978
12. Dogan A, Avsar A, Ozturk M. P-wave dispersion for predicting maintenance of sinus rhythm after cardioversion of atrial fibrillation. The American Journal of Cardiology. 2004;93(3):368–71. DOI: 10.1016/j.amjcard.2003.09.064
13. Park MY, Shin SH, Oh WJ, Lim HE, Pak HN, Lim DS et al. Prognostic Implication of the Left Atrial Appendage Mechanical Reserve After Cardioversion of Atrial Fibrillation. Circulation Journal. 2008;72(2):256–61. DOI: 10.1253/circj.72.256
14. Osmanagic A, Möller S, Osmanagic A, Sheta HM, Vinther KH, Egstrup K. Left Atrial Sphericity Index Predicts Early Recurrence of Atrial Fibrillation After Direct-Current Cardioversion: An Echocardiographic Study. Clinical Cardiology. 2016;39(7):406–12. DOI: 10.1002/clc.22545
Review
For citations:
Aydın C. Possible predictors of stroke in patients with atrial microfibrillation. Kardiologiia. 2023;63(5):40-46. https://doi.org/10.18087/cardio.2023.5.n2158
Views:
531
Email this article 
Post a Comment 
