SPC365

Can we better select patients with cryptogenic stroke for Implantable Loop Recorders? - The importance of atrial strain as a predictor of subclinical Atrial Fibrillation

Session: Comunicações Orais - Sessão 10 - Imagem em Cardiologia
Speaker: ANGELA MARGARIDA MARTINS DE CASTRO

Congress: CPC 2024
Topic: B. Imaging
Theme: 03. Imaging
Subtheme: 03.6 Cross-Modality and Multi-Modality Imaging Topics
Session Type: Comunicações Orais
FP Number: ---
Authors: Margarida De Castro; Mariana Tinoco; Luísa Pinheiro; Catarina Gonçalves; Joana Gomes; Marina Fernandes; Olga Azevedo; Lucy Calvo; Sílvia Ribeiro; João Português; Victor Sanfins; António Lourenço

<h1><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-size:12.0pt">Background:</span></u><span style="font-size:12.0pt"> S<span style="color:black">tudies using Implantable Loop Recorders (ILR) have reported AF detection rates surpassing 17% in Cryptogenic Stroke (CS). Peak Atrial Longitudinal Strain (PALS), also known as reservoir atrial strain, has emerged as a marker of Left Atrial (LA) fibrosis and proposed as a potential predictor of subclinical AF in patients (pts) with CS. </span></span></span></span></h1>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="color:black">We sought to clarify if PALS was an independent predictor of subclinical AF in pts with CS who implanted ILR. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-size:12.0pt"><span style="color:black">Methods</span></span></u><span style="font-size:12.0pt"><span style="color:black">: </span></span><span style="font-size:12.0pt">Retrospective study including pts with ILR for investigation of CS aetiology. </span><span style="font-size:12.0pt"><span style="color:black">Subclinical</span></span><span style="font-size:12.0pt"> AF diagnosis by ILR was reviewed by an experienced arrythmologist and considered related to CS if detected up to 1 year after CS.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">Pts with and without subclinical AF were compared regarding clinical and echocardiographic parameters at the time of CS. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">LA PALS was obtained through 2D-speckle tracking echocardiography on apical 4 and 2 chamber views by two independent operators in order to assess reproducibility through Intraclass Correlation Coefficient (ICC). Regression analyses were performed to find independent predictors of subclinical AF. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:NewsGotT"><u><span style="color:black">Results:</span> </u><span style="font-family:&quot;Calibri&quot;,sans-serif">We included 67 pts (mean age of 64.42&plusmn;12,01 years; 59.7% males). Subclinical AF was detected in 24% of pts (N=16) with a median time until diagnosis of 9 months. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:NewsGotT"><span style="font-family:&quot;Calibri&quot;,sans-serif">Both operators obtained excellent intra-rater (ICC .976 and .951) and inter-rater reliability (ICC .919 and .915) in PALS assessment. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:NewsGotT">A binary logistic regression showed that pts with subclinical AF had higher weight, dyslipidaemia, and lateral E/e&rsquo;, along with lower global PALS. Through ROC-derived cutoffs, pts with global PALS &lt;25.50% exhibited a higher rate of subclinical AF in Kaplan-Meier survival analysis with a sensitivity of 0.912 and specificity of 0.392 as well as LA volume index (LAVI) &lt;28.45ml/m<sup>2</sup>, weight &gt;75.50kg, and age &gt;67.50 years. Univariate and multivariate Cox regression showed that global PALS &lt;25.50% and LAVI &lt;28.45ml/m<sup>2</sup> were independent predictors of increased risk of subclinical AF. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-size:12.0pt"><span style="color:black">Conclusions</span></span></u><span style="font-size:12.0pt"><span style="color:black">:<strong><em> </em></strong></span></span><span style="font-size:12.0pt">Global PALS &lt;25.50% and LAVI &lt;28.45ml/m<sup>2</sup> were independent <span style="color:black">predictors of subclinical</span> AF detection by ILR in this cohort. Future studies are needed to validate cutoff values of PALS for AF prediction and confirm that therapeutic decisions based on PALS values result in clinical benefit. This study suggests that PALS may allow a premature diagnosis of atrial cardiomyopathy in a subclinical phase and a better selection of candidates for ILR implantation. </span></span></span></p>