ASSOCIATION OF LEFT ATRIAL STRAIN WITH ATRIAL FIBRILLATION IN ACUTE ISCHEMIC STROKE PATIENTS

Abstract

Background: Acute ischemic stroke due to cardio-embolism associated with atrial fibrillation (AF) has been known to have the highest risk of recurrence and increased patient morbidity and mortality. However, the detection rate of AF rhythm in acute ischemic stroke patients using electrocardiograms and Holter monitoring was still quite low. Functional changes in the left atrium have been associated with an increased incidence of AF. Left atrial strain measurement using speckle tracking echocardiography 2D (STE-2D) can detect left atrial dysfunction associated with AF.

Aim: To determine the association between left atrial strain and atrial fibrillation in patients with acute ischemic stroke.

Research Methods: This analytical observation study was conducted with a cross-sectional design, using secondary data from medical records at RSUP Dr. Sardjito within January 2020–December 2022 on the population with acute ischemic stroke patients who underwent an electrocardiogram and transthoracic echocardiography examination.

Results: During the observation period 142 acute ischemic stroke patients underwent an electrocardiogram and transthoracic echocardiography examinations. A total of 72 patients diagnosed with acute ischemic stroke met the inclusion criteria as study subjects, there were 49 subjects (68%) with sinus rhythm and 23 subjects (32%) with AF rhythm. The left atrial strain value was found to be lower in the AF rhythm group (13,02 ± 8,49%) than in the sinus rhythm group (25,12 ± 8,36%) and was statistically significant (p <0,001). Determination of the optimal cut-off value using the Youden Index obtained a left atrial strain value < 16,25% with a sensitivity of 85,7%, specificity of 73,9%, and area under the curve (AUC) value of 84% (p < 0,001, 95% CI 0,74 – 0,95). The results of the multivariate analysis test showed that left atrial strain was an independent predictor related to the occurrence of AF rhythm (p = 0,001, OR 18,68; 95% CI 3,22 – 108,45).

Conclusion: Decreased left atrial strain ​​is associated with atrial fibrillation rhythms in acute ischemic stroke patients. Acute ischemic stroke patients with a left atrial strain value < 16.25% have a higher prevalence of atrial fibrillation rhythm.

Keywords: left atrial strain; atrial fibrillation; ischemic stroke; speckle tracking echocardiography