Atrial Electromechanical Interval May Predict Cardioembolic Stroke in Apparently Low Risk Elderly Patients with Paroxysmal Atrial Fibrillation. Issue 2 (30th July 2013)

• Record Type: Journal Article
• Authors: Hoshi, Yoko; Nozawa, Yukinaga; Ogasawara, Makoto; Yuda, Satoshi; Sato, Shoko; Sakasai, Takuya; Oka, Makoto; Katayama, Harumi; Sato, Masaya; Kouzu, Hidemichi; Nishihara, Masahiro; Doi, Atsushi; Nishimiya, Takatoshi; Miura, Tetsuji
• Is Part Of: Echocardiography. Volume 31:Issue 2(2014)
• Page Start: 140
• Page End: 148
• Publication Date: 2013-07-30
• Subjects: Echocardiography -- Periodicals; Echocardiography -- Periodicals; 616.1207543
• DOI: 10.1111/echo.12329
• Languages: English
• ISSNs: 0742-2822

Abstract

<abstract abstract-type="main" id="echo12329-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="echo12329-sec-0001" sec-type="section"> <title>Background</title> <p>A considerable number of patients with atrial fibrillation (AF) develop cardioembolic stroke (CE) despite low CHADS<sub>2</sub> score. We examined the possibility that use of the atrial electromechanical interval (AEMI) improves prediction of CE in patients with paroxysmal AF (PAF), particularly those with low CHADS<sub>2</sub> score.</p> </sec> <sec id="echo12329-sec-0002" sec-type="section"> <title>Methods</title> <p>We consecutively enrolled 108 patients with nonvalvular PAF and 52 healthy subjects as controls. The PAF patients were divided into 2 groups depending on presence (n = 36) or absence (n = 72) of the history of CE. Left atrial (LA) volume index (LAVI), peak myocardial velocity during late diastole (a'), and AEMI as time from onset of P‐wave to onset of lateral a' were measured.</p> </sec> <sec id="echo12329-sec-0003" sec-type="section"> <title>Results</title> <p>Patients with PAF had significantly larger LAVI, longer AEMI, and lower lateral a' than those in controls. Area under the curves for LAVI, lateral a', and AEMI for identifying patients with PAF were 0.70, 0.69, and 0.88, respectively. Multivariate logistic regression analysis indicated that age, use of antiarrhythmic drugs, and AEMI, but not LAVI or a', were independently associated with history of CE in patients with PAF. PAF patients were categorized into low risk by CHADS<sub>2</sub> score (i.e. CHADS<sub>2</sub> score = 0 or 1, n = 60), those with prolonged AEMI (>82 msec) had significantly higher rates of CE than those with ≤82 msec (48% vs. 15%, P < 0.05).</p> </sec> <sec id="echo12329-sec-0004" sec-type="section"> <title>Conclusion</title> <p>As compared with echocardiographic parameters of LA size and LA function, AEMI appears to be more useful for identifying PAF patients. AEMI may enable to detect high risk PAF patients, especially those categorized into low risk by CHADS<sub>2</sub> score.</p> </sec> </abstract>