Three-dimensional analysis of the left atrial appendage for detecting paroxysmal atrial fibrillation in acute ischemic stroke

• Published in: International journal of stroke Vol. 9; no. 8; p. 1045
• Main Authors: Tanaka, Koji, Koga, Masatoshi, Sato, Kazuaki, Suzuki, Rieko, Minematsu, Kazuo, Toyoda, Kazunori
• Format: Journal Article
• Language: English
• Published: United States 01.12.2014
• Subjects: Aged; Aged, 80 and over; Atrial Fibrillation - diagnosis; Atrial Fibrillation - etiology; Atrial Function, Left; Brain Ischemia - complications; Echocardiography, Transesophageal - methods; Female; Humans; Imaging, Three-Dimensional; Male; Middle Aged; Regression Analysis; ROC Curve; Stroke - complications; Stroke - etiology; volume measurement; atrial fibrillation; left atrial appendage; ejection fraction; ischemic stroke; real-time three-dimensional transesophageal echocardiography
• ISSN: 1747-4949
• DOI: 10.1111/ijs.12268

Atrial fibrillation impairs left atrial appendage function and the thrombus formation in the left atrial appendage is a major cause of cardioembolic stroke. To evaluate the association between the volume of the left atrial appendage measured by real-time three-dimensional transesophageal echocardiography and presence of paroxysmal atrial fibrillation in patients with cerebral infarction or transient ischemic attack. Real-time three-dimensional transesophageal echocardiography was performed to measure left atrial appendage end-diastolic and end-systolic volumes to calculate left atrial appendage ejection fraction. Patients with normal sinus rhythm at the time of real-time three-dimensional transesophageal echocardiography were divided into groups with and without paroxysmal atrial fibrillation. Volumetric data were corrected with the body surface area. Of 146 patients registered, 102 (29 women, 72·2 ± 10·7 years) were normal sinus rhythm at the examination. In 23 patients with paroxysmal atrial fibrillation, left atrial appendage end-diastolic volume (4·78 ± 3·00 ml/m(2) vs. 3·14 ± 2·04 ml/m(2), P = 0·003) and end-systolic volume (3·10 ± 2·47 ml/m(2) vs. 1·39 ± 1·56 ml/m(2), P < 0·001) were larger and left atrial appendage ejection fraction (37·3 ± 19·1% vs. 57·1 ± 17·5%, P < 0·001) was lower than in the other 79 patients without paroxysmal atrial fibrillation. The optimal cutoff for left atrial appendage peak flow velocity to predict paroxysmal atrial fibrillation was 39·0 cm/s (sensitivity, 54·6%; specificity, 89·7%; c-statistic, 0·762). The cutoffs for left atrial appendage end-diastolic volume, end-systolic volume, and ejection fraction were 4·52 ml/m(2) (sensitivity, 47·8%; specificity, 82·3%; c-statistic, 0·694), 1·26 ml/m(2) (sensitivity, 91·3%; specificity, 60·3%; c-statistic, 0·806), and 47·9% (sensitivity, 78·3%; specificity, 74·7%; c-statistic, 0·774), respectively. In multivariate analysis, all these parameters were independently associated with paroxysmal atrial fibrillation after adjusting for sex, age, diabetes mellitus, and previous stroke. Left atrial appendage volumetric analysis by real-time three-dimensional transesophageal echocardiography is a promising method for detecting paroxysmal atrial fibrillation in acute cerebral infarction or transient ischemic attack.