Echocardiographic measures of atrial function may predict atrial fibrillation in stroke patients

Objective: In patients with a prior stroke or transient ischemic attack (TIA) and atrial fibrillation anticoagulant treatment is indicated. This study's purpose was to investigate if echocardiography can predict unknown AF in patients after stroke. Design: Prospectively, 174 stroke/TIA patients without diagnosed AF underwent echocardiographic evaluation including tissue Doppler imaging (TDI) focusing on functional parameters of the left atrium and left ventricular diastolic function. AF screening was performed during 30 d. Results: Fifteen patients (8.6%) were diagnosed with AF. Echocardiography in the AF group compared to those without AF, showed larger left atrial volume index (LAVI), (37.2 ± 6.7 vs. 31.6 ± 8.6 ml/m 2 , p = 0.018), lower A' velocities in ventricular (5.9 ± 2.2 vs. 7.2 ± 1.6, p = 0.010) and atrial (4.8 ± 1.4 vs. 5.9 ± 1.4, p = 0.013) septa, higher LAVI/A' in ventricular septum (6.7 (5.0-8.7) vs. 4.2 (3.2-5.5), p = 0.001) and atrial septum (8.5 (5.9-11.0) vs. 5.1 (4.1-6.8), p = 0.003). Receiver operating characteristic analyses to detect AF was performed, area under the curve for LAVI was 0.71 (0.61-0.83), p = 0.008, and for LAVI/A' in ventricular septum 0.76 (0.59-0.93), p = 0.006 and atrial septum 0.78 (0.63-0.93), p = 0.002, respectively. Conclusions: LAVI and measures of atrial contraction as measured by TDI predict unknown AF in patients after an stroke/TIA and may be used to detect silent AF.