A lower left atrial appendage peak emptying velocity in the acute phase of cryptogenic stroke predicts atrial fibrillation occurrence during follow‐up

• Published in: Echocardiography (Mount Kisco, N.Y.) N.Y.), 2019-10, Vol.36 (10), p.1859-1868
• Main Authors: Farinha, José Maria, Parreira, Leonor, Marinheiro, Rita, Fonseca, Marta, Mesquita, Dinis, Gonçalves, Sara, Miranda, Carla, Silvestre, Isabel, Caria, Rui
• Format: Article
• Language: English
• Subjects: atrial dysfunction; atrial fibrillation; atrial stunning; cryptogenic stroke; ischemic stroke; left atrial appendage peak emptying velocity
• ISSN: 0742-2822; 1540-8175
• DOI: 10.1111/echo.14478

Background Silent atrial fibrillation is a frequent etiology of cryptogenic stroke. Spontaneous conversion of atrial fibrillation to sinus rhythm results in atrial stunning. Objective To evaluate if the presence of a lower left atrial appendage peak emptying velocity (LAAV) after a cryptogenic stroke is associated with the occurrence of atrial fibrillation (AF). Methods We retrospectively selected consecutive patients with an acute ischemic stroke that had a transoesophageal echocardiogram (TEE) performed in the first 30 days of the acute event. Documented AF or potential cardioembolic sources in the TEE were considered exclusion criteria. We assessed the LAAV. During follow‐up, we evaluated the occurrence of new‐onset AF and the combined endpoint of death or new ischemic stroke. Results We studied 73 consecutive patients, during a mean follow‐up period of 54.9 ± 19.3 months. Seven developed AF, and 13 had the combined endpoint. LAAV was independently associated with AF occurrence (HR: 0.93, 95% CI: 0.88–0.99; P = .016). Patients with a LAAV ≤ 46.5 cm/s (AUC: 0.766, 95% CI: 0.579–0.954; P = .021) had a lower survival rate free from AF occurrence (Log‐rank, P