Echocardiographic Parameters for Predicting Atrial Fibrillation Following Ischemic Stroke: The PER DIEM Echocardiography Substudy

Background: Atrial fibrillation (AF) detection following ischemic stroke is critical to guide management. Echocardiography (echo) is commonly performed poststroke and may help identify candidates for prolonged rhythm monitoring. The PER DIEM trial randomized poststroke patients without known AF to 12-months of implantable loop recorder (ILR) monitoring versus 30-days of external rhythm monitoring and demonstrated higher AF detection rates using ILR. Aims: This substudy of the PER DIEM trial investigated the association between baseline echo parameters and poststroke AF detection. Methods: PER DIEM trial participants with complete transthoracic echo performed at the time of ischemic stroke were included. Demographic, clinical, and echocardiographic parameters were compared between those with and without AF. Results: Nineteen (12.4%) of the 153 patients included had poststroke AF. AF patients were significantly older and had higher CHA2DS2-VASc scores. Patients with AF had higher left atrial volume index (LAVI), lower absolute left ventricular global longitudinal strain (LV GLS) and lower contractile LA strain compared to those without AF. Univariate analysis showed that a higher LAVI (OR 1.30 per 5 mL/m2 increase, 95%CI 1.03–1.64, p = 0.025) and lower absolute LV GLS (OR 2.73 per 5% decrease, 95%CI 1.37–6.04, p = 0.007) were significantly associated with poststroke AF, with optimal cutoff values of 32.12 mL/m2 and 15.5%, respectively. Conclusions: In patients with ischemic stroke, LAVI and LV GLS were significantly associated with subsequent AF detection. These findings may help risk stratify AF monitoring strategies for postischemic stroke management.