AUTHOR=Alonso Angelika , Kraus Josephine , Ebert Anne , Nikolayenko Valeriya , Kruska Mathieu , Sandikci Vesile , Lesch Hendrik , Duerschmied Daniel , Platten Michael , Baumann Stefan , Szabo Kristina , Akin Ibrahim , Fastner Christian 

TITLE=Left atrial area index provides the best prediction of atrial fibrillation in ischemic stroke patients: results from the LAETITIA observational study

JOURNAL=Frontiers in Neurology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1237550

DOI=10.3389/fneur.2023.1237550

ISSN=1664-2295

ABSTRACT=Background and aims: Left atrium (LA) enlargement has been repeatedly shown to be associated with the diagnosis of atrial fibrillation (AF). In clinical practice, several parameters are available to determine LA enlargement: LA diameter index (LADI), LA area index (LAAI), or LA volume index (LAVI). We investigated the predictive power of these individual LA parameters for AF in patients with acute ischemic stroke or transient ischemic attack (TIA).
Methods: LAETITIA is a retrospective observational study that reflects the clinical reality of acute stroke care in Germany. Consecutive patient cases with acute ischemic cerebrovascular event (CVE) in 2019 and 2020 were identified from the Mannheim stroke database. Predictive power of each LA parameter was determined by the area under the curve (AUC) of receiver operating characteristics curves. A cutoff value was determined. Multiple logistic regression analysis was performed to confirm the strongest LA parameter as an independent predictor of AF in patients with acute ischemic CVE.
Results: 1910 patient cases were included. 82.0% of patients had suffered a stroke, 18.0% a TIA. Patients presented with a distinct cardiovascular risk profile (reflected by a CHA2DS2-VASc score ≥2 prior to hospital admission in 85.3% of patients) and were moderately affected on admission (median NIHSS score 3 (1; 8)). 19.4% of patients had pre-existing AF, and 8.0% were newly diagnosed with AF. LAAI had the greatest AUC of 0.748, LADI of 0.706 and LAVI of 0.719 (each p<0.001 versus (vs.) diagonal; AUC-LAAI vs. AUC-LADI p=0.030, AUC-LAAI vs. AUC-LAVI p=0.004). LAAI, NIHSS score and systolic heart failure were identified as independent predictors of AF in patients with acute ischemic CVE. To achieve a clinically relevant specificity of 70%, a cutoff for LAAI of ≥10.3 cm2/m2 was determined (sensitivity of 69.8%).
Conclusions: LAAI revealed the best prediction of AF in patients with acute ischemic CVE and was confirmed as an independent risk factor. An LAAI cutoff value of 10.3 cm2/m2 could serve as inclusion criterion for intensified AF screening in patients with embolic stroke of undetermined source in subsequent studies.