Left atrial function to identify patients with atrial fibrillation at high risk of stroke: new insights from a large registry
AbstractAimsAtrial fibrillation (AF) is an independent risk factor for ischaemic stroke. The CHA2DS2-VASc is the most widely used risk stratification model; however, echocardiographic refinement may be useful, particularly in low risk AF patients. The present study examined the association between advanced echocardiographic parameters and ischaemic stroke, independent of CHA2DS2-VASc score.Methods and resultsOne thousand, three hundred and sixty-one patients (mean age 65 ±12 years, 74% males) with first diagnosis of AF and baseline transthoracic echocardiogram were followed by chart review for the occurrence of stroke over a mean of 7.9 years. Left atrial (LA) volumes, LA reservoir strain, P-wave to A′ duration on tissue Doppler imaging (PA-TDI, reflecting to tal atrial conduction time), and left ventricular (LV) global longitudinal strain (GLS) were evaluated in patients with and without stroke. The independent association of these echocardiographic parameters with the occurrence of ischaemic stroke was evaluated with Cox proportional hazard models. One -hundred patients (7%) developed an ischaemic stroke, representing an annualized stroke rate of 0.9%. The incident stroke rate in the year following the first diagnosis of AF was 2.6% in the entire population and higher than the remainder of the follow-up period. Left atrial reservoir (14.5% vs. 18. 9%,P = 0.005) and conduit strains were reduced (10.5% vs. 13.5%,P = 0.013...
Conclusions: Statin therapy for AF-related stroke may reduce all-cause mortality and improve functional outcomes. Randomized controlled studies are warranted to confirm the effects of statins on the outcomes of AF-related stroke.
CONCLUSIONS: In highly selected patients at very HBR, discontinuation of any antithrombotic therapy after LAAC appears safe and feasible. PMID: 32999093 [PubMed - in process]
Atrial fibrillation (AF) and heart failure (HF) carry a poor prognosis in acute ischaemic stroke (AIS). The impact of revascularisation therapies on outcomes in these patients is not fully understood.
ConclusionsIn the treatment of AF, CA appeared to be superior to AADs, decreasing the risk of all-cause death and cardiovascular hospitalization and improving the long-term QoL of patients with AF. CA was better tolerated and more effective than pharmacological therapy and allowed for improved QoL.
Atrial fibrillation (AF) is the most common arrhythmia, with a substantial rise in global incidence and prevalence. Ischemic stroke is a frequent complication of AF, since AF perfectly fulfills Virchow's triad of blood stasis, vascular damage and hypercoagulation, making oral anticoagulation (OAC) obligatory for stroke prevention. Direct oral anticoagulants (DOAC), such as dabigatran, which inhibits thrombin, and apixaban, edoxaban and rivaroxaban, which block the activated coagulation factor X (FXa), have some advantages and are largely replacing coumarin-based OAC.
We examined the association between LDL-C levels and incident stroke in patients with atrial fibrillation treated with direct oral anticoagulants (DOACs).
AbstractPurposeOptimal stroke prevention strategies for patients with atrial fibrillation (AF) who experience a major bleed are poorly defined. We sought to estimate the effectiveness and safety of oral anticoagulation (OAC) represcription after an OAC contraindication.MethodsTREAT-AF is a retrospective cohort study of patients with newly diagnosed AF (2004 –2012), treated in the Veterans Health Administration. From this cohort, we identified patients with a contraindication to OAC after AF diagnoses, defined as incident intracranial bleeding, non-intracranial bleeding requiring hospitalization, or unrepaired cerebra...
ConclusionIn NVAF patients of all ages initiating either apixaban or warfarin for stroke prevention in the Sentinel System, apixaban was associated with a decreased risk of GI bleeding, ICH, and ischemic stroke compared with warfarin. Among patients less than 65 years of age, apixaban use was associated with a decreased risk of GI bleeding and ischemic stroke.
ConclusionsPostoperative implantation of a permanent RV pacemaker does not alter the long ‐term risks of HF and mortality following mitral valve surgery.
ConclusionsA high NLR on admission could be a useful marker for predicting poor short ‐term outcome in patients with mild AIS following IVT.