Left Atrial Strain Helps Identifying the Cardioembolic Risk in Transient Ischemic Attacks Patients with Silent Paroxysmal Atrial Fibrillation

Figures & data

Figure 1 Strain curves from left atrial speckle-tracking, in apical four-chamber and two-chamber.

Table 1 Baseline Demographics of the Patients with Transient Ischemic Attacks

	With PAF	Without PAF	P value	All Patients
	n=48	n=142
Age (y)	67.5 ± 6.9	60.0 ± 7.4	<0.0001	64±7
Male sex (n, %)	25 (52)	97 (68)	0.04	122 (64)
Systolic BP (mmHg)	134.2 ± 25.9	131.9 ± 22.0	0.55	132.5±23.7
Diastolic BP (mmHg)	74.7 ± 14.4	72.5 ± 14.2	0.83	73.9±14.3
Heart rate (beats/min)	91 ± 24	88 ± 20	0.39	89±22
Body mass index (kg/m^2)	26.5 ± 5.3	25.5 ± 4.7	0.21	25.9±5.1
Obesity (n, %)	5 (10)	10 (7)	0.50	15 (8)
Smoker (n, %)	10 (20)	20 (14)	0.32	30 (16)
Hypertension (n, %)	38 (80)	96 (65)	0.07	134 (70)
Diabetes mellitus (n, %)	12 (24)	20 (14)	0.10	32 (17)
Thyroid disease (n, %)	4 (8.3)	15 (10.6)	0.54	19 (10)
Dyslipidemia (n, %)	19 (40)	45 (32)	0.31	64 (34)
Ischemic heart disease (n, %)	15 (23)	23 (16)	0.20	38 (20)
Heart failure (n, %)	17 (35)	3 (26)	0.23	20 (10)
PAD (n, %)	4 (0.83)	10 (0.70)	0.92	14 (7)
COPD (n, %)	10 (21%)	21 (15)	0.41	31 (17)
End stage renal disease (n, %)	1 (0.02)	6 (0.04)	0.94	7 (3)
Previous stroke or TIA (n, %)	31 (65%)	33 (23%)	<0.0001	44 (23)
CHA2DS2-VASc score (mean ± 1 SD)	5.7±1.5	4.6±1.9	<0.001	4.9±1.7
0–1	8 (17)	44 (31)		52 (28)
≥2	40 (83)	98 (69)	0.04	138 (72)

Note: Statistically significant values are shown in bold (P<0.05).

Abbreviations: TIA, transient ischemic attack; PAF, paroxysmal atrial fibrillation; BP, blood pressure; COPD, chronic obstructive pulmonary disease.

Table 2 Echocardiography

	With PAF	Without PAF	P value	All Patients
	n=48	n=142
LVEDV (mL)	97.4±21.2	103.5±19.9	0.07	99.2±20.4
LVESD (mL)	46 ± 11	49.3±12.6	0.10	47.3±10.6
LVMI (g/m2)	145 ± 43	137 ± 36	0.20	141 ± 40
LVEF (%)	58 ± 7	62 ± 14	0.05	60.5±9.4
Mitral E/A-ratio	1.3 ± 0.5	1.2 ± 0.4	0.16	1.2±0.6
EDT	148 ± 53	154 ± 45	0.45	151 ± 48
Septal E/E´	13.8 ± 5.2	13.1 ± 3.8	0.32	11.3 ± 3.8
TAPSE (cm)	2.4 ± 0.47	2.4 ± 0.50	1	2.4±0.49
GLS (%)	−14.4 ± 3.1	−15.2 ± 3.2	0.13	−14.7±3.2
LAVI (mL/m2)	50.5 ± 14.0	43.5 ± 10.3	<0.001	47 ± 20
LAEF (%)	47.9 ± 4.9	59.7 ± 5.9	<0.0001	56.3±7.3
LA strain (%)	14.89 ± 1.21	16.83 ± 2.54	<0.0001	16.24 ± 2.14
LA RV strain (%)	20.2±4.5	23.8±3.6	<0.0001	21.9±5.1
LA CD strain (%)	12.1±2.6	13.4±2.8	0.001	12.1 ±3.1
LA BP strain (%)	10.2±3.2	12.3±3.4	<0.001	10.9 ±3.8

Note: Statistically significant values are shown in bold (P<0.05).

Abbreviations: LVEDV, left ventricular end diastolic volumeș; LVESV, left ventricular end systolic volumes; LVEF, left ventricular ejection fraction; E, peak transmitral early diastolic inflow; A, peak transmitral late diastolic inflow; EDT, E/E´TAPSE, tricuspid annular plane systolic excursion; GLS global longitudinal strain; LA, left atrium; LAVI, indexed left atrial volume; LAEF, left atrial total emptying fraction; RV, reservoir; CD, conduit; BP, booster pump.

Figure 2 Comparison of left atrial echocardiographic measurements in transient ischemic attack patients.

Abbreviations: LA, left atrium; PAF, paroxysmal atrial fibrillation; LAVI, indexed left atrial volume; LAEF, left atrial total emptying fraction; LAS, left atrial global strain; LARVS, left atrial reservoir strain; LACDS, left atrial conduit strain, LABPS, left atrial booster pump strain.

Table 3 Factors Associated with Paroxysmal Atrial Fibrillation in Patients with Transient Ischemic Attacks

Parameter	Univariable OR (95% CI)	P	Multivariable OR (95% CI)	P
Age	1.25 (1.17–1.34)	<0.0001	0.64 (0.45–0.88)	<0.01
Female gender	2.15 (1.10–4.20)	0.02
LAVI	1.05 (1.02–1.08)	<0.001
LAEF	0.67 (0.59–0.76)	<0.0001	0.49 (0.32–0.74)	<0.001
LAS	0.70 (0.60–0.83)	<0.0001
LARVS	0.79 (0.72–0.87)	<0.0001	1.55 (1.23–1.94)	<0.001
LACDS	0.84 (0.74–0.95)	<0.01
LABPS	0.83 (0.74–0.92)	<0.001

Note: Statistically significant values are shown in bold (P<0.05).

Abbreviations: OR, odds ratio; LAVI, indexed left atrial volume; LAEF, left atrial total emptying fraction; LAS, left atrial global strain; LA, left atrium; RV, reservoir; CD, conduit; BP, booster pump.

Figure 3 Comparison of receiver-operating characteristic curves of the independent variables associated with paroxysmal atrial fibrillation.

Abbreviations: ROC, receiver-operating characteristic; PAF, paroxysmal atrial fibrillation; LAEF, left atrial total emptying fraction; LARVS, left atrial reservoir strain.