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23.08.2023 | Original Communication

Left atrial appendage flow velocity predicts occult atrial fibrillation in cryptogenic stroke: a CRYPTON-ICM registry

verfasst von: Yuji Ueno, Nobukazu Miyamoto, Kenichiro Hira, Ryosuke Doijiri, Hidekazu Yamazaki, Kazutaka Sonoda, Junpei Koge, Tomonori Iwata, Kenichi Todo, Hiroshi Yamagami, Naoto Kimura, Masafumi Morimoto, Daisuke Kondo, Shuhei Okazaki, Masatoshi Koga, Eiichiro Nagata, Nobutaka Hattori, the CRYPTON-ICM investigators

Erschienen in: Journal of Neurology | Ausgabe 12/2023

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Abstract

Background

An insertable cardiac monitor (ICM) and transesophageal echocardiography (TEE) are useful for investigating potential embolic sources in cryptogenic stroke, of which atrial fibrillation (AF) is a critical risk factor for stroke recurrence. The association of left atrial appendage flow velocity (LAA-FV) on TEE with ICM-detected AF is yet to be elucidated.

Methods

CRYPTON-ICM (CRYPTOgenic stroke evaluation in Nippon using ICM) is a multicenter registry of cryptogenic stroke with ICM implantation, and patients whose LAA-FV was evaluated on TEE were enrolled. The primary outcome was the detection of AF (> 2 min) on ICM. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off of LAA-FV, and factors associated with ICM-detected AF were assessed.

Results

A total of 307 patients (age 66.6 ± 12.3 years; 199 males) with median follow-up of 440 (interquartile range 169–726) days were enrolled; AF was detected in 101 patients. The lower-tertile LAA-FV group had older age, more history of congestive heart failure, and higher levels of B-type natriuretic peptide (BNP) or N-terminal proBNP (all P < 0.05). On ROC analysis, LAA-FV < 37.5 cm/s predicted ICM-detected AF with sensitivity of 26.7% and specificity of 92.2%. After adjustment for covariates, the lower tertile of LAA-FV (hazard ratio [HR], 1.753 [1.017–3.021], P = 0.043) and LAA-FV < 37.5 cm/s (HR 1.987 [1.240–3.184], P = 0.004) predicted ICM-detected AF.

Conclusions

LAA-FV < 37.5 cm/s predicts AF. TEE is useful not only to evaluate potential embolic sources, but also for long-term detection of AF on ICM by measuring LAA-FV in cryptogenic stroke. http://www.umin.ac.jp/ctr/ (UMIN000044366).

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Titel: Left atrial appendage flow velocity predicts occult atrial fibrillation in cryptogenic stroke: a CRYPTON-ICM registry
verfasst von: Yuji Ueno
Nobukazu Miyamoto
Kenichiro Hira
Ryosuke Doijiri
Hidekazu Yamazaki
Kazutaka Sonoda
Junpei Koge
Tomonori Iwata
Kenichi Todo
Hiroshi Yamagami
Naoto Kimura
Masafumi Morimoto
Daisuke Kondo
Shuhei Okazaki
Masatoshi Koga
Eiichiro Nagata
Nobutaka Hattori
the CRYPTON-ICM investigators
Publikationsdatum: 23.08.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Journal of Neurology / Ausgabe 12/2023
Print ISSN: 0340-5354
Elektronische ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-023-11942-5

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