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...
Source: European Heart Journal - Category: Cardiology Source Type: research

Related Links:

We examined the association between LDL-C levels and incident stroke in patients with atrial fibrillation treated with direct oral anticoagulants (DOACs).
Source: The American Journal of Medicine - Category: General Medicine Authors: Source Type: research
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...
Source: Journal of Interventional Cardiac Electrophysiology - Category: Cardiology Source Type: research
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.
Source: Journal of General Internal Medicine - Category: Internal Medicine Source Type: research
ConclusionsPostoperative implantation of a permanent RV pacemaker does not alter the long ‐term risks of HF and mortality following mitral valve surgery.
Source: Journal of Cardiac Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: ORIGINAL ARTICLE Source Type: research
ConclusionsA high NLR on admission could be a useful marker for predicting poor short ‐term outcome in patients with mild AIS following IVT.
Source: Brain and Behavior - Category: Neurology Authors: Tags: ORIGINAL RESEARCH Source Type: research
AbstractBackgroundWomen undergoing atrial fibrillation catheter ablation (AFCA) have higher rates of vascular complications and major bleeding. However, most studies have been underpowered to detect differences in rarer complications such as stroke/transient ischemic attack (TIA) and procedural mortality.MethodsWe performed a systematic review of databases (PubMed, World of Science, Embase) to identify studies published since 2010 reporting AFCA complications by sex. Six complications of interest were: 1) vascular/groin complications; 2) pericardial effusion/tamponade; 3) stroke/TIA; 4) permanent phrenic nerve injury; 5) m...
Source: Journal of Cardiovascular Electrophysiology - Category: Cardiology Authors: Tags: ORIGINAL ‐ ELECTROPHYSIOLOGY Source Type: research
TUESDAY, Sept. 22, 2020 -- Exposure to air pollution may increase the risk for ischemic stroke in patients with atrial fibrillation (AF), according to a study published online Sept. 15 in JAMA Network Open. Zachary J. Rhinehart, M.D., from the...
Source: Drugs.com - Pharma News - Category: Pharmaceuticals Source Type: news
Conclusions: The rivaroxaban users had a 3-day shorter LOS-OAC after IPTW-adjustment. Using rivaroxaban was associated with a 4 to 5 days shorter LOS-OAC than using warfarin in patients with mild or moderate stroke, though treatment selection did not have a large impact in patients with severe stroke. PMID: 32936057 [PubMed - as supplied by publisher]
Source: Journal of Medical Economics - Category: Health Management Tags: J Med Econ Source Type: research
AbstractPurposeThe purpose of the present study was to compare the long-term effectiveness and safety of newly initiated anticoagulation with edoxaban (EDO) versus uninterrupted vitamin K antagonist (VKA) therapy in patients with atrial fibrillation (AF) scheduled for transesophageal echocardiogram (TEE)-guided direct electrical current cardioversion (DCC).MethodsA propensity score-matched cohort observational study was performed comparing the safety and effectiveness of edoxaban versus well-controlled VKA therapy among a cohort of consecutive non-valvular AF patients scheduled for DCC. The primary safety outcome was major...
Source: Cardiovascular Drugs and Therapy - Category: Cardiology Source Type: research
Conclusion: COVID-19-related ischemic events can present as small vessel occlusions, branch emboli or large vessel occlusions. The most common etiology is cryptogenic. Patients with LVO syndromes tend to be younger, male and may have elevated acute inflammatory markers.
Source: Frontiers in Neurology - Category: Neurology Source Type: research
More News: Atrial Fibrillation | Cardiology | Heart | Ischemic Stroke | Stroke | Study