open access

Vol 23, No 4 (2016)
ARRHYTMOLOGY Original articles
Published online: 2016-06-10
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Factors associated with stroke in patients with paroxysmal atrial fibrillation beyond CHADS2 score

Min-Kyung Kang, Chaehoon Han, Kwang Jin Chun, Jaehuk Choi, Seonghoon Choi, Jung-Rae Cho, Namho Lee
DOI: 10.5603/CJ.a2016.0028
·
Pubmed: 27296157
·
Cardiol J 2016;23(4):429-436.

open access

Vol 23, No 4 (2016)
ARRHYTMOLOGY Original articles
Published online: 2016-06-10

Abstract

Background: This study was conducted to investigate factors associated with stroke in pa­tients with paroxysmal atrial fibrillation (PAF) beyond CHADS2 score in terms of left ventricular (LV) diastolic function or left atrial (LA) function.

Methods: One hundred and sixty-one patients with PAF and age less than 75 (mean age 61 ± 10; 69 male) who underwent transthoracic echocardiography were investigated. Patients were divided into two groups according to the stroke status (group 1 — no stroke vs. group 2 — presence of stroke). Baseline echocardiographic parameters and LA segmental (4 segments: basal septal, lateral, inferior, and anterior) strain rate (SR) during normal sinus rhythm were analyzed.

Results: CHAD score (except S2) was similar between the two groups (0.6 ± 0.7 vs. 0.9 ± 0.7, p = 0.125). Patients with stroke had slightly lower body mass index (24.5 ± 2.7 vs. 23.4 ± ± 2.4, p = 0.052). Echocardiographic parameters did not show any differences in both systolic and diastolic functions between the two groups, however elevated E/E’ ratio was noted (9.5 ± ± 3.8 vs. 11.6 ± 3.9, p = 0.010) due to higher E velocity (63.5 ± 15.9 vs. 70.9 ± 16.0 cm/s, p = 0.046). In the analysis of LA SR, there are no differences of SR among the 4 segments. However, standard deviations (SD) of time to peak SR (SD of tA-SR) of the 4 segments were higher in patients with stroke (10.9 ± 9.9 vs. 22.1 ± 18.1 ms, p = 0.009) which indicates dyssynchronous contraction of LA. In multivariate analysis, SD of tA-SR (OR 1.074, CI 1.024–1.128, p = 0.004) and elevated E/E’ (OR 1.189, CI 1.006–1.406, p = 0.048) were independently associated with stroke in patients with PAF.

Conclusions: Elevated E velocity, E/E’ and SD of tA-SR were associated with occurrence of stroke in patients with PAF even with similar CHAD scores. Increased SD of tA-SR and E/E’ were independently associated with stroke in patients with PAF. (

Abstract

Background: This study was conducted to investigate factors associated with stroke in pa­tients with paroxysmal atrial fibrillation (PAF) beyond CHADS2 score in terms of left ventricular (LV) diastolic function or left atrial (LA) function.

Methods: One hundred and sixty-one patients with PAF and age less than 75 (mean age 61 ± 10; 69 male) who underwent transthoracic echocardiography were investigated. Patients were divided into two groups according to the stroke status (group 1 — no stroke vs. group 2 — presence of stroke). Baseline echocardiographic parameters and LA segmental (4 segments: basal septal, lateral, inferior, and anterior) strain rate (SR) during normal sinus rhythm were analyzed.

Results: CHAD score (except S2) was similar between the two groups (0.6 ± 0.7 vs. 0.9 ± 0.7, p = 0.125). Patients with stroke had slightly lower body mass index (24.5 ± 2.7 vs. 23.4 ± ± 2.4, p = 0.052). Echocardiographic parameters did not show any differences in both systolic and diastolic functions between the two groups, however elevated E/E’ ratio was noted (9.5 ± ± 3.8 vs. 11.6 ± 3.9, p = 0.010) due to higher E velocity (63.5 ± 15.9 vs. 70.9 ± 16.0 cm/s, p = 0.046). In the analysis of LA SR, there are no differences of SR among the 4 segments. However, standard deviations (SD) of time to peak SR (SD of tA-SR) of the 4 segments were higher in patients with stroke (10.9 ± 9.9 vs. 22.1 ± 18.1 ms, p = 0.009) which indicates dyssynchronous contraction of LA. In multivariate analysis, SD of tA-SR (OR 1.074, CI 1.024–1.128, p = 0.004) and elevated E/E’ (OR 1.189, CI 1.006–1.406, p = 0.048) were independently associated with stroke in patients with PAF.

Conclusions: Elevated E velocity, E/E’ and SD of tA-SR were associated with occurrence of stroke in patients with PAF even with similar CHAD scores. Increased SD of tA-SR and E/E’ were independently associated with stroke in patients with PAF. (

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Keywords

paroxysmal atrial fibrillation, stroke, left atrium, strain rate

About this article
Title

Factors associated with stroke in patients with paroxysmal atrial fibrillation beyond CHADS2 score

Journal

Cardiology Journal

Issue

Vol 23, No 4 (2016)

Pages

429-436

Published online

2016-06-10

DOI

10.5603/CJ.a2016.0028

Pubmed

27296157

Bibliographic record

Cardiol J 2016;23(4):429-436.

Keywords

paroxysmal atrial fibrillation
stroke
left atrium
strain rate

Authors

Min-Kyung Kang
Chaehoon Han
Kwang Jin Chun
Jaehuk Choi
Seonghoon Choi
Jung-Rae Cho
Namho Lee

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