Using speckle tracking strain of left atrium for risk stratification of embolic stroke in non valvular atrial fibrillation in single cardiac center
Dr. Ghazi F Haji, Dr. Ismail Attiya Hussein, Dr. Ahmed Yousif Hasan
Background: Atrial fibrillation (AF) is the most common arrhythmia treated in clinical practice and the most common arrhythmia for which patients are hospitalized. AF is associated with an approximately five fold increase in the risk for stroke and a two fold increase in the risk for all-cause mortality. Objective of study: To investigate myocardial deformation of the left atrium (LA) assessed by two-dimensional speckle tracking echocardiography in patients with nonvalvular atrial fibrillation and its value for risk stratification of embolic stroke. Patient and Methods: A prospective cohort study in Baghdad teaching hospital cardiac center from June 2016 to May 2017 We recruited 107 consecutive patients who were referred to echocardiography unit for evaluation by 2D full echocardiographic study with speckle tracking strain of left atrium. These patients were divided into two groups control and AF. those with AF further divided into two groups according to the presence or absence of stroke. Results: The left atrial strain among patients with AF and stroke had significantly reduced from those patient with AF without stroke(9.8 ±3.0, 18.5±5.6 respectively).P- value= 0.001. Where as left atrial volume index and left ventricular filling index (E/E`ratio) did not show significant differences. After multi-variant analysis, global LA strain were independently associated with stroke in patients with AF. Those with LA GLS <12.8 % had a significantly higher rates of stroke than those with LA GLS > 12.8 %. Conclusion: This study demonstrated that LA deformation reduced in patients with AF and stroke. Global LA strain measured by speckle tracking echocardiography can be used for risk stratification for stroke in patients with AF and has incremental diagnostic values in addition to clinical risk stratification.