Objectives

To determine the prognostic value of positive global left atrial strain (LA-GSA+), measured by two-dimensional speckle tracking echocardiography (2D-STE) in a population of acute ischemic stroke (AIS) patients without atrial fibrillation (AF), in the setting of Emergency Department (ED).

Methods

All consecutive AIS patients with sinus rhythm on ECG and without AF history entered this prospective study. All patients underwent complete blood tests and transthoracic echocardiography implemented with 2D-STE analysis of LA strain parameters within 6–12 h after symptoms onset. At 6-months follow-up, we evaluated the composite endpoint of all-cause mortality plus cardiovascular re-hospitalizations.

Results

A total of 102 AIS patients (76.4 ± 10.8 yrs, 47% males) were prospectively included. LA-GSA+ was markedly reduced in AIS patients (20.8 ± 7.7%), without any statistically significant difference between the stroke subtypes. At 6-months follow-up, 7 deaths and 27 re-hospitalizations occurred. On multivariate Cox regression analysis, variables independently associated with outcome were: LA-GSA+ (per unit) (HR 0.29, 95% CI 0.19–0.39) and C-reactive protein (CRP) (per 0.1 mg/dl) (HR 1.45, 95% CI 1.15–1.75) as continuous variables; statin therapy (HR 0.45, 95%CI 0.28–0.62), and type 2 diabetes (HR 1.65, 95% CI 1.15–2.35) as categorical variables. A LA-GSA+ ≤20.0% predicted the occurrence of the above-mentioned outcome at 6-months follow-up with 94% sensitivity and 81% specificity (AUC=0.84). Interestingly, GSA+ showed a strong inverse correlation with CRP levels (r = -0.86).

Conclusions

A LA-GSA+ ≤20% reflects a more advanced atrial cardiomyopathy and might provide a rapid and reliable prognostic risk stratification of AIS patients without AF history in the setting of ED.

中文翻译：

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急诊科急性缺血性脑卒中患者的快速风险分层：左心房储备应变的增量预后作用

目标

为了确定通过二维斑点跟踪超声心动图 (2D-STE) 在无心房颤动 (AF) 的急性缺血性卒中 (AIS) 患者群体中测量的整体左心房应变 (LA-GSA+) 的预后价值，在急诊科 (ED) 的设置。

方法

心电图显示窦性心律且无房颤病史的所有连续 AIS 患者都进入了这项前瞻性研究。所有患者在症状出现后 6-12 小时内接受了完整的血液检查和经胸超声心动图，并通过 2D-STE 分析 LA 应变参数。在 6 个月的随访中，我们评估了全因死亡率加上心血管再住院的复合终点。

结果

总共有 102 名 AIS 患者（76.4 ± 10.8 岁，47% 为男性）被前瞻性纳入。AIS 患者的 LA-GSA+ 显着降低 (20.8 ± 7.7%)，中风亚型之间没有任何统计学显着差异。在 6 个月的随访中，发生了 7 例死亡和 27 例再次住院。在多变量 Cox 回归分析中，与结果独立相关的变量是：LA-GSA+（每单位）（HR 0.29，95% CI 0.19–0.39）和 C 反应蛋白（CRP）（每 0.1 mg/dl）（HR 1.45， 95% CI 1.15–1.75) 作为连续变量；他汀类药物治疗 (HR 0.45, 95% CI 0.28–0.62) 和 2 型糖尿病 (HR 1.65, 95% CI 1.15–2.35) 作为分类变量。LA-GSA+ ≤20.0% 以 94% 的敏感性和 81% 的特异性（AUC=0.84）预测了 6 个月随访时上述结果的发生。有趣的是，r  = -0.86）。

结论

LA-GSA+ ≤ 20% 反映更晚期的心房心肌病，并可能为 ED 背景下无 AF 病史的 AIS 患者提供快速可靠的预后风险分层。