Document Detail


Association between Paroxysmal Atrial Fibrillation and the Left Atrial Appendage Ejection Fraction during Sinus Rhythm in the Acute Stage of Stroke: A Transesophageal Echocardiographic Study.
MedLine Citation:
PMID:  23608370     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: This study aimed to investigate whether left atrial appendage (LAA) dysfunction evaluated by transesophageal echocardiography (TEE) during sinus rhythm is predictable of paroxysmal atrial fibrillation (PAF) as an embolic source in the acute stage of stroke. METHODS AND RESULTS: We measured and analyzed LAA flow velocity (LAA-FV) and LAA ejection fraction (LAA-EF) in 300 acute ischemic stroke patients by TEE. We divided the acute ischemic stroke patients into 3 groups. The atrial fibrillation (AF) group (n = 58) comprised patients whose TEE was performed during AF rhythm. The PAF group (n = 42) comprised patients with a history of AF but with normal sinus rhythm when TEE was performed. The normal sinus (sinus) group (n = 200) did not have any history of AF. We found that mean LAA-FV and LAA-EF values in the PAF group were significantly lower than those in the sinus group (P < .001). The diagnostic accuracy of LAA-FV for the diagnosis of PAF calculated as the area under receiver operating characteristic curves was low (.582, 95% confidence interval [CI] = .498-.665) but that of LAA-EF was modest (.721, 95% CI = .653-.789), with an optimal cutoff point of 49.1%. CONCLUSIONS: LAA dysfunction as determined by TEE (LAA-EF < 49.1%) in the acute stage of stroke is predictive of PAF with moderate accuracy. Long-term electrocardiographic monitoring is recommended for cryptogenic stroke patients with LAA dysfunction.
Authors:
Takahiro Shimizu; Tatsuro Takada; Atsuko Shimode; Yuichi Fujita; Noriko Usuki; Bunta Kato; Satoshi Takaishi; Toshikazu Hirayama; Kazuhiko Hanzawa; Yasuhiro Hasegawa
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-4-20
Journal Detail:
Title:  Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association     Volume:  -     ISSN:  1532-8511     ISO Abbreviation:  J Stroke Cerebrovasc Dis     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-4-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9111633     Medline TA:  J Stroke Cerebrovasc Dis     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.
Affiliation:
Division of Neurology, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan. Electronic address: shimi-taka@marianna-u.ac.jp.
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