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Left Atrial Stiffness as a predictor of subclinical Atrial Fibrillation and a marker of stroke recurrence in a cohort of patients with Cryptogenic Stroke
Session:
Comunicações Orais - Sessão 17 - Miscelânea
Speaker:
ANGELA MARGARIDA MARTINS DE CASTRO
Congress:
CPC 2024
Topic:
P. Other
Theme:
37. Miscellanea
Subtheme:
05.5 Atrial Fibrillation - Stroke Prevention
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Margarida De Castro; Mariana Tinoco; Luísa Pinheiro; Catarina Gonçalves; Marina Fernandes; Olga Azevedo; Joana Gomes; Lucy Calvo; Sílvia Ribeiro; João Português; Victor Sanfins; António Lourenço
Abstract
<p style="text-align:justify"><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"> <span style="color:black">Recent studies based on implantable Loop Recorders (ILR) have reported an AF detection rate over 17% in patients (pts) with Cryptogenic Stroke (CS).</span></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"><span style="color:black">L</span></span><span style="font-size:12.0pt">eft atrial (LA) remodelling with diffuse and focal fibrosis has been associated with atrial fibrillation (AF). </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">Therefore, we hypothesized that LA stiffness index (LASI) may be associated with AF and stroke recurrence in pts with CS. </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 imaging-proven CS, who performed transthoracic echocardiogram and implanted ILR within 6 months of the event. </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 the CS if detected up to 1 year after CS.</span> <span style="font-size:12.0pt">Pts with and without subclinical AF and patients with and without stroke recurrence 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 reservoir strain (LASr) was measured twice by two independent operators through 2D-speckle tracking echocardiography on apical 4 and 2 chamber views. LA stiffness index (LASI) was derived from: the ratio between the mitral peak E-wave velocity and the mitral annular e’ velocity (E/e´) divided by the LASr (</span><em><span style="font-size:12.0pt"><span style="font-family:"Cambria Math",serif">E</span></span></em><em><span style="font-size:12.0pt"><span style="font-family:"Cambria Math",serif">/</span></span></em><em><span style="font-size:12.0pt"><span style="font-family:"Cambria Math",serif">e</span></span></em><em><span style="font-size:12.0pt"><span style="font-family:"Cambria Math",serif">’</span></span></em><em> |</em><em><span style="font-size:12.0pt"><span style="font-family:"Cambria Math",serif">LASr</span></span></em><em> </em><span style="font-size:12.0pt">).</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">Regression analyses was performed to find independent predictors. </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="color:black">:</span><strong><em> </em></strong>We included 67 pts with CS (mean age 64±12 years, 60% men). <span style="color:black">Subclinical AF was detected in 24% (n=16) of pts after a median ILR follow-up of 9 months. A total of 21 pts (31.3%) experienced recurrent stroke in the following year. </span> </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:NewsGotT"><span style="font-family:"Calibri",sans-serif">Both operators obtained excellent intra-rater (ICC .976 and .951) and inter-rater reliability (ICC .919 and .915) in LASr assessment. </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:NewsGotT">LASI was significatively higher in pts with subclinical AF (0,42<span style="font-family:"Calibri",sans-serif">±</span>0,18 vs 0,31<span style="font-family:"Calibri",sans-serif">±0,15, </span><span style="font-family:"Calibri",sans-serif">p </span><span style="font-family:"Calibri",sans-serif">= 0,033</span>) and in pts with recurrent stroke (0,44<span style="font-family:"Calibri",sans-serif">±</span>0,13 vs 0,30<span style="font-family:"Calibri",sans-serif">±0,17, </span><span style="font-family:"Calibri",sans-serif">p </span><span style="font-family:"Calibri",sans-serif">= 0,028</span>). </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:NewsGotT">Through ROC-derived cutoffs, pts with LASI > 0,35 (sensitivity of 0,67 and specificity of 0.65) exhibited a higher rate of AF in Kaplan-Meier survival analysis. Univariate and multivariate Cox regression showed that LASI was an independent predictor of subclinical AF (p=0,016; HR 26,86). </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">: </span></span><span style="font-size:12.0pt">The LASI showed to be an independent predictor of subclinical AF in patients with CS and it was also associated with stroke recurrence. Future studies are needed to validate this cutoff value and its usefulness in the better selection of patients for ILR implantation</span><span style="font-size:12.0pt"> in the context of CS. </span></span></span></p>
Slides
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