Utility of left atrial strain for predicting atrial fibrillation following ischemic stroke.

Twenty-five percent of ischemic strokes (IS) are cryptogenic, but it is estimated that paroxysmal atrial fibrillation (PAF) is the underlying cause in up to a third of cases. We aimed to investigate the predictive value of speckle tracking of the left atrium (LA) in diagnosing PAF in IS patients. We retrospectively studied 186 IS patients with a clinical echocardiographic examination during sinus rhythm. Outcome was PAF defined by at least one reported episode of AF following their IS. Conventional echocardiographic measures were performed. Global longitudinal strain (GLS), LA reservoir-(ε), conduit-(ε), contraction-strain (ε) and LA dyssynchrony (standard deviation of time-to-peak ε; LA SD-T2P) were obtained by left ventricular and LA speckle tracking. Of 186 patients, 28 (15%) were diagnosed with PAF. PAF-patients did not differ from non-PAF patients with regards to GLS nor SD-TPS, but atrial strain measures were significantly impaired at baseline (ε 27 vs. 35%, ε 12 vs. 16%, ε 15 vs. 18%, p < 0.02 for all, for PAF and non-PAF, respectively). However, only ε remained independently associated with PAF after adjustment for clinical and echocardiographic parameters (OR 1.13 [1.04; 1.22], p = 0.003, per 1% decrease). ε also provided the highest area under the receiver operating characteristic curve among all variables (AUC = 0.74). With a cutoff of 29%, ε had a specificity of 76% and a negative predictive value of 93%. Atrial reservoir strain is independently associated with PAF and may be used to improve the diagnosis of PAF following IS.