Cryptogenic stroke, left atrial function, and atrial fibrillation: a complex relationship.

IF 3.7 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Research in Cardiology Pub Date : 2025-09-02 DOI:10.1007/s00392-025-02743-z

Francesca Augusta Gabrielli, Gianluigi Bencardino, Antonio Di Renzo, Serena Abruzzese, Francesca Colò, Pasquale Alessandro Festa, Lorenzo Severo, Federico Ballacci, Gaetano Antonio Lanza, Antonella Lombardo, Gemma Pelargonio, Aldobrando Broccolini

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引用次数: 0

Abstract

Background: Paroxysmal atrial fibrillation (AF) may underlie some embolic strokes of undetermined source (ESUS), but the widespread use of loop recorders (LRs) to detect it may not be cost-effective. This study evaluated whether assessing left atrial (LA) function by speckle tracking echocardiography (STE) could help to identify ESUS patients most likely to benefit from LR monitoring for AF detection.

Methods: Consecutive ESUS patients diagnosed between 2020 and 2023, who underwent LR implantation and comprehensive echocardiographic evaluation, including STE, were enrolled. Patients were divided into two groups based on AF detection by LR over a median follow-up of 10.0 months (IQR 6.0-21.7).

Results: A total of 64 patients were included: 27 (42.2%) with AF (AF group) and 37 (57.8%) without AF (No-AF group). Compared to the No-AF group, patients in the AF group showed a significantly larger left atrial volume index (LAVi: 44.7 ± 10.8 vs. 34.4 ± 8.3 mL/m²; p < 0.001), a lower LA longitudinal strain of reservoir (LASr: 19.7 ± 8.9% vs. 27.4 ± 9.5%; p = 0.003) and contraction (LASct: 7.4 ± 6.5% vs. 12.4 ± 7.2%; p = 0.008), and an increased LA stiffness index (LASi: 0.6 ± 0.3 vs. 0.3 ± 0.2; p < 0.001). In multivariable Cox regression analysis, only LAVi and LASct remained independent predictors of AF.

Conclusions: LAVi and LASct appear useful and reliable predictors of AF occurrence during follow-up in ESUS patients and may aid in selecting those who are most likely to benefit from LR implantation.

查看原文本刊更多论文

隐源性卒中、左心房功能和心房颤动：复杂的关系。

背景：阵发性心房颤动（AF）可能是一些来源不明的栓塞性中风（ESUS）的基础，但广泛使用环路记录仪（LRs）来检测它可能不具有成本效益。本研究评估了斑点跟踪超声心动图（STE）评估左心房（LA）功能是否有助于识别ESUS患者最有可能从LR监测中获益。方法：纳入2020年至2023年间诊断的连续ESUS患者，这些患者接受了LR植入和综合超声心动图评估，包括STE。患者根据中位随访10.0个月（IQR 6.0-21.7）的LR检测AF分为两组。结果：共纳入64例患者：AF组27例（42.2%），非AF组37例（57.8%）。与无房颤组相比，房颤组患者的左房容积指数明显较大（LAVi: 44.7±10.8 vs 34.4±8.3 mL/m2）；结论：在ESUS患者随访期间，LAVi和LASct是房颤发生的有用和可靠的预测指标，可能有助于选择那些最有可能从LR植入中获益的患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Research in Cardiology 医学-心血管系统

CiteScore

11.40

自引率

4.00%

发文量

140

审稿时长

4-8 weeks

期刊介绍： Clinical Research in Cardiology is an international journal for clinical cardiovascular research. It provides a forum for original and review articles as well as critical perspective articles. Articles are only accepted if they meet stringent scientific standards and have undergone peer review. The journal regularly receives articles from the field of clinical cardiology, angiology, as well as heart and vascular surgery. As the official journal of the German Cardiac Society, it gives a current and competent survey on the diagnosis and therapy of heart and vascular diseases.